2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 83 Services that are covered for you What you must pay when you get these services in-network and out-of-network The following screening tests are covered: Medicare-covered colorectal · Colonoscopy has no minimum or maximum age cancer screening exam, limitation and is covered once every 120 months (10 excluding barium enemas, and years) for patients not at high risk, or 48 months after a colonoscopy. previous flexible sigmoidoscopy for patients who are There is no coinsurance, not at high risk for colorectal cancer, and once every 24 copayment, or deductible for months for high risk patients after a previous screening each Medicare-covered barium colonoscopy or barium enema. enema. · Flexible sigmoidoscopy for patients 45 years and older. If you have a prior history of Once every 120 months for patients not at high risk colon cancer, or have had after the patient received a screening colonoscopy. polyps removed during a Once every 48 months for high risk patients from the previous colonoscopy, ongoing last flexible sigmoidoscopy or barium enema. colonoscopies are considered · Screening fecal-occult blood tests for patients 45 years diagnostic and are subject to and older. Once every 12 months. cost-sharing as described under the outpatient surgery cost- · Multitarget stool DNA for patients 45 to 85 years of age sharing in this chart. Therefore, and not meeting high risk criteria. Once every 3 years. the screening colonoscopy · Blood-based Biomarker Tests for patients 45 to 85 benefit is not available for years of age and not meeting high risk criteria. Once members who have signs or every 3 years. symptoms prior to the · Barium Enema as an alternative to colonoscopy for colonoscopy. patients at high risk and 24 months since the last A colonoscopy or screening barium enema or the last screening sigmoidoscopy conducted for colonoscopy. polyp removal or biopsy is a · Barium Enema as an alternative to flexible surgical procedure subject to sigmoidoscopy for patient not at high risk and 45 years the outpatient surgery cost- or older. Once at least 48 months following the last sharing described later in this screening barium enema or screening flexible chart. sigmoidoscopy. Colorectal cancer screening tests include a follow-up screening colonoscopy after a Medicare covered non- invasive stool-based colorectal cancer screening test returns a positive result.