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).
• Cervical Human Papillomavirus (HPV) testing
  • every 5 years for asymptomatic women 30-65y with Pap test (2015).
• Lung cancer screening with low dose computed tomography (LDCT)
  • annually for asymptomatic beneficiaries 55–77y with 30+pack-years smoking history (current or former smokers- quit within 15 years) (2015).

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.