Does Medicare cover parasite stool tests?
Medicare should cover a parasite poop test when medically necessary, usually when a person has symptoms of gastroenteritis or a history of exposure to a parasite.
Each year in the United States, about
Though many of these hospitalizations are caused by viral gastroenteritis, parasitic organisms such as Cryptosporidium and Giardia can also infect the gastrointestinal tract and cause gastroenteritis.
This article discusses Medicare coverage of stool testing to detect parasites, including eligibility and cost.
Laboratory technicians perform a stool ova and parasites (O&P) test by examining a stool sample a person has collected at home. Medicare generally covers this test if a doctor considers it medically necessary.
This may be the case when symptoms suggest parasitic gastroenteritis or there has been a potential exposure to a parasite, such as during recent travel, from contaminated water, or during known outbreaks.
Medicare should cover an O&P test when a person has experienced acute diarrhea lasting at least 1 week or persistent diarrhea for 2 to 4 weeks.
Other symptoms that may prompt a referral to the test include blood in stool, fever, dehydration, or stomach pain.
Doctors are more likely to order the test for individuals who are hospitalized or immunocompromised. Typically, a person will need to collect several stool samples over a few days.
The price of an O&P test without insurance varies by the lab performing the analysis, and Medicare’s coverage depends on which part of the plan applies as follows:
Medicare may also cover other stool tests if considered medically necessary. For instance, it may cover a fecal occult blood test (FOBT) to detect hidden blood in stool. This can be a sign of colorectal cancer, ulcers, or other digestive problems. Medicare covers one test annually for people ages 45 and older.
Medicare may also cover a multitarget stool DNA test, such as Cologuard, which screens for hidden blood and genetic markers of colon cancer. Under certain conditions, Medicare covers this test for adults ages 45 to 85 years.
Foodborne illness affects millions of people in the United States each year, with older adults facing the greatest risk of severe outcomes.
Parasitic infections may contribute to the prevalence of stomach illness more than is recognized, and stool testing offers a way to diagnose them.
Medicare generally covers O&P testing when symptoms or risk factors point to parasitic gastroenteritis, though the details of coverage depend on the specific Medicare plan.