Medicare covers preventive screening colonoscopy at $0 cost-sharing — but only if no polyp is found. If a polyp is removed during your 'screening' colonoscopy, the procedure is reclassified as diagnostic and cost-sharing applies. Here is what to know.
Data source: CMS 2026 Medicare Physician Fee Schedule (MPFS) and OPPS Final Rule.
Based on CMS 2026 MPFS & OPPS Final Rules
Preventive Screening Colonoscopy
No deductible, no coinsurance — if purely diagnostic with no polyp removal
$0
Diagnostic Colonoscopy (HOPD)
If polyp found/removed, or ordered for symptoms — 20% coinsurance applies
~$160–$280
Physician Fee (CPT 45378)
6.59 RVU × $33.4009 conversion factor
~$220
HOPD Facility Fee
CMS 2026 OPPS APC 5301 (Level 1 GI Endoscopy)
~$586
ASC Facility Fee
CMS 2026 ASC Final Rule
~$390
Anesthesia / Sedation
Moderate sedation or monitored anesthesia care (MAC)
~$200–$500
Your Cost — Screening (no polyp)
Full coverage, no deductible
$0
Your Cost — Diagnostic (no Medigap)
After Part B deductible; 20% of approved amount
~$160–$280
The 'screening to diagnostic' reclassification is one of the most common Medicare billing surprises. Always ask your gastroenterologist before the procedure what happens if a polyp is found.
Medicare Part B covers preventive screening colonoscopy at 100% — no deductible, no coinsurance — for beneficiaries at average risk (every 10 years) or high risk (every 2 years).
If a polyp is removed during a screening colonoscopy, the procedure is reclassified as therapeutic/diagnostic and the 20% coinsurance applies.
The Part B deductible ($283 in 2026) does NOT apply to purely preventive screening colonoscopy.
Anesthesia for colonoscopy is typically moderate sedation (included in facility fee) or monitored anesthesia care (MAC), billed separately.
A diagnostic colonoscopy (ordered due to symptoms like rectal bleeding or abdominal pain) is subject to the standard 20% coinsurance and Part B deductible.
Costs vary significantly by location and provider
Medicare pays physicians based on Geographic Practice Cost Indices (GPCI) that differ by locality. Your actual out-of-pocket cost depends on your deductible status, supplemental insurance, and whether your providers accept Medicare assignment. Use our free calculator for a personalized estimate.
Enter your location, insurance type, and deductible status for a precise out-of-pocket breakdown — surgeon fee, facility fee, anesthesia, and post-op costs all included.
Open Free CalculatorFree · No sign-up · Based on 2026 CMS official data
Data sources: CMS 2026 Medicare Physician Fee Schedule (MPFS), 2026 Outpatient Prospective Payment System (OPPS) Final Rule, and 2026 Ambulatory Surgical Center (ASC) Payment System. Estimates are for educational purposes only and do not constitute medical or financial advice.