Frequently Asked Questions

Yes — this is one of the most important distinctions in Medicare billing. A screening colonoscopy (routine, no symptoms) is covered 100% by Medicare Part B with no cost to you — no deductible, no coinsurance. However, if polyps are found and removed during the same procedure, Medicare reclassifies it as a diagnostic/therapeutic colonoscopy, and your normal 20% coinsurance applies. Always confirm with your provider whether your procedure will be billed as screening or diagnostic before scheduling.

My uncle needed knee surgery. When he asked me how much it would cost under Medicare, I realized neither of us knew the answer — and finding out wasn't easy. Medicare bills are complicated: a single surgery generates multiple bills from different providers, each with its own rules. For older adults on fixed incomes, financial surprises aren't just stressful — they're genuinely risky. That's why I built this. Not to give a perfect number, but to give people a real starting point — so they can make informed decisions before they're sitting in a hospital gown.

This site is maintained by a healthcare finance professional based on the West Coast, with hands-on experience across hospital systems and healthcare supply chain operations. It was built with one goal in mind: to help patients understand what Medicare actually costs before they need it.

Medicare.gov provides general coverage information and plan comparison tools. It does not calculate your specific out-of-pocket cost for a particular surgery based on your insurance type, location, and deductible status. This calculator uses the actual 2026 CMS physician fee schedule (RVU × GPCI × conversion factor), DRG facility fees, and anesthesia unit formulas to produce a line-by-line estimate — the same methodology used by hospital billing departments.

Most patients are surprised to learn that a single surgery generates 3–5 separate bills: (1) Surgeon fee — billed under Part B, calculated from RVUs adjusted for your geographic area. (2) Facility fee — billed by the hospital or surgery center under Part A or Part B, depending on setting. (3) Anesthesia fee — billed separately by the anesthesiologist, calculated in 15-minute time units. (4) Assistant surgeon fee — 16% of the surgeon fee if applicable. (5) Pre-op clearance and labs — separate Part B charges before the procedure. This calculator breaks down all five components.

The calculator uses official 2026 CMS data: the Medicare Physician Fee Schedule (MPFS), Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center (ASC) rates, and DRG inpatient rates. Physician fees are adjusted by your specific Medicare locality using GPCI values. Estimates are most accurate for Original Medicare (Part A + B) without complications. Medicare Advantage plans have their own networks and cost-sharing that cannot be estimated without plan-specific data.

Medicare Advantage (Part C) plans set their own cost-sharing rules, networks, and prior authorization requirements. This calculator is designed for Original Medicare (Part A + B) with or without a Medigap supplement. If you have Medicare Advantage, use this tool to understand what Original Medicare would pay, then contact your plan for your specific cost-sharing.

Currently supported: Total Knee Replacement (CPT 27447), Total Hip Replacement (CPT 27130), Cataract Surgery (CPT 66984), Colonoscopy (CPT 45378), Upper GI Endoscopy (CPT 43239), and Epidural Injection (CPT 64483). We are working toward covering the Top 20 most common Medicare surgeries — new procedures are being added regularly. Check back for updates as content continues to expand.

Yes, completely free. No sign-up, no account required. This tool was built to help Medicare patients, not to collect data or sell services.