Medicare Colonoscopy Cost 2026 | Out-of-Pocket Estimator
Diagnostic colonoscopy (CPT 45378) is covered under Medicare Part B. Preventive screening colonoscopies are free; diagnostic colonoscopies (for symptoms or polyp removal) require standard 20% coinsurance.
2026 Medicare Cost Summary — Colonoscopy (CPT 45378)
Source: CMS 2026 MPFS, OPPS Final Rule, ASC Final Rule, IPPS. All amounts are national averages.
| Cost Component | Medicare-Approved Amount | Your Share (20%) |
|---|---|---|
| Surgeon Fee — Colonoscopy (CPT 45378) | $164 | $33 |
| Hospital Outpatient (HOPD) Facility Fee | $950 | $190 |
| Ambulatory Surgery Center (ASC) Facility Fee | $891 | $178 |
| Anesthesia (estimated) | $200–$400 | 20% of approved |
What Medicare Pays
Medicare pays 80% of the approved amount for Part B services after your $283 annual deductible. With no supplemental insurance, you owe the remaining 20% with no annual out-of-pocket cap. With Medigap Plan G, you pay only the $283 Part B deductible — everything else is covered. With Medigap Plan N, you pay the $283 deductible plus a $20 copay per visit.
About This Calculator
MediCostCalc uses 2026 CMS official fee schedules — the Medicare Physician Fee Schedule (MPFS), Outpatient Prospective Payment System (OPPS), Ambulatory Surgical Center (ASC) Final Rule, and Inpatient Prospective Payment System (IPPS) — to give you a personalized, line-item cost estimate. No sign-up required. All data is from official CMS sources.
Is a Colonoscopy Free Under Medicare?
It depends on the reason. Screening colonoscopies — routine preventive exams with no prior symptoms — are covered at 100% with no cost to you: no deductible, no coinsurance. Medicare covers one screening colonoscopy every 24 months for high-risk patients, or every 10 years for average-risk patients.
However, if the procedure is ordered because of symptoms (abdominal pain, rectal bleeding, altered bowel habits), it becomes a diagnostic colonoscopy — and the standard 20% coinsurance applies.
The Polyp Rule: When a Free Screening Becomes a Paid Procedure
This catches many patients off guard. If a polyp is found and removed during a screening colonoscopy, the procedure is reclassified from preventive to therapeutic. Under traditional Medicare, you now owe coinsurance. As of 2023, the Consolidated Appropriations Act began phasing this coinsurance down: it started at 20%, is decreasing annually, and is scheduled to reach 0% by 2030. Check your current year's benefit for the exact percentage.
Practical tip: Ask your doctor before the procedure whether it will be billed as preventive or diagnostic, and whether your previous colonoscopy history affects your screening interval.
Colonoscopy Cost Breakdown: ASC vs. Hospital
| Setting | Facility Fee | Your 20% |
|---|---|---|
| Ambulatory Surgery Center (ASC) | $632 | $126 |
| Hospital Outpatient Dept (HOPD) | $916 | $183 |
Choosing an ASC over a hospital outpatient department saves approximately $57 in facility fee coinsurance. Add the gastroenterologist fee (~$44) and propofol anesthesia (~$40–$80) for the total diagnostic colonoscopy cost at an ASC: approximately $210–$250 without Medigap.