Upper GI endoscopy (EGD — esophagogastroduodenoscopy) is one of the most common outpatient procedures for Medicare beneficiaries. Unlike colonoscopy, there is no free 'screening' version — all EGDs are diagnostic and subject to standard cost-sharing.
Data source: CMS 2026 Medicare Physician Fee Schedule (MPFS) and OPPS/ASC Final Rules.
Based on CMS 2026 MPFS & OPPS Final Rules
Physician Fee (CPT 43239)
5.83 RVU × $33.4009 conversion factor — EGD with biopsy
~$195
ASC Facility Fee
CMS 2026 ASC Final Rule — most EGDs done in ASCs
~$390
HOPD Facility Fee
CMS 2026 OPPS APC 5301 — higher cost than ASC
~$586
Anesthesia / Sedation
Moderate sedation or monitored anesthesia care (MAC)
~$150–$400
Pathology (biopsy)
If tissue samples taken — billed separately by pathology lab
~$80–$200
Your 20% Share (no Medigap)
After Part B deductible; ASC setting
~$120–$200
With Medigap Plan G
Only the annual Part B deductible
~$283
Unlike colonoscopy, there is no preventive/screening EGD benefit under Medicare. All upper endoscopies are diagnostic and subject to the standard 20% coinsurance and Part B deductible.
Medicare Part B covers diagnostic upper GI endoscopy (EGD) — pays 80% after the $283 Part B deductible.
There is no free 'screening' EGD benefit under Medicare (unlike colonoscopy). All EGDs are diagnostic.
If a biopsy is taken, the pathology lab bill is separate and also subject to 20% coinsurance.
Most EGDs are performed in ambulatory surgery centers (ASCs), which have lower facility fees than hospital outpatient departments.
Anesthesia for EGD may be moderate sedation (bundled) or MAC (billed separately) — ask your facility in advance.
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.