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SEER-Medicare: Cancer Testing Covered by Medicare

Until relatively recently, Medicare did not cover many preventive services. Below is a list of cancer-related preventive services and the date in parentheses when Medicare began to provide coverage.

  • Screening mammography:
    • biennially for women 50+ (1991).
    • annually for women 40+ (1998).
  • Screening PSA:
    • annually (2000).
  • Colorectal screening:
    • Fecal Occult Blood Test every 12 months (1998).
    • flexible sigmoidoscopy every 4 years for beneficiaries 50+ (1998).
    • colonoscopy every 2 years for high risk persons (1998).
    • colonoscopy every 10 years for persons not at high risk (July 1, 2001).
  • Pap smear:
    • every 3 years for low risk women and every 2 years for high risk women (July 1, 1990 through June 2001).
    • every 2 years for low risk women (as of July 1, 2001).
  • Pelvic examinations and clinical breast exams along w/pap test:
    • every 3 years for low risk women (January 1, 1998 through June 2001).
    • every 2 years for low risk women (as of July 1, 2001).
    • annually for high risk women (as of January 1, 1998).

It is important to note that it is difficult to distinguish screening from diagnostic tests. Inclusion of only the screening codes will result in a significant undercount of true screening rates. In addition, tests that were not billed to Medicare will not be captured in these data. Examples of this are mammograms performed in a mobile clinic as part of a community outreach or PSA tests done in community settings.

Last Modified: 18 Oct 2013