HaggleCare

Colonoscopy: What Should It Cost?

A preventive colonoscopy is covered 100% by most insurance plans — but billing errors often convert it to a diagnostic procedure with cost-sharing. Know what was done before paying.

Medicare Rates for Common Colonoscopy Codes

These are the 2025 national Medicare reimbursement rates. Hospital charges for uninsured patients are typically 3–10x higher.

CPT CodeDescriptionMedicare (Non-Facility)Medicare (Facility)
45378Colonoscopy, diagnostic$342.86$182.06
45380Colonoscopy with biopsy$436.47$197.92
45385Colonoscopy with polyp removal$456.45$249.93
43239Upper GI Endoscopy with Biopsy$378.59$136.78
43235Upper GI Endoscopy, diagnostic$290.79$121.44

Common Billing Errors for Colonoscopy

  • !Preventive colonoscopy billed as diagnostic after polyp removal (common and often incorrect)
  • !Anesthesia or sedation billed separately at facility rates
  • !Pathology for biopsies billed by a separate lab without disclosure
  • !Recovery room charges added for a procedure that doesn't require extended recovery

How to Negotiate Your Colonoscopy Bill

  1. 1If you had polyps removed during a screening colonoscopy, verify it was still billed as preventive
  2. 2Ask your insurance company whether polyp removal during a screening changes your cost-sharing
  3. 3Request the operative report to verify what procedure codes were actually used
  4. 4Challenge separate pathology bills — ask whether they can be combined with the main bill

Related Guides

Other Procedure Guides

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Medicare rates shown are 2025 national averages from the CMS Physician Fee Schedule. Rates vary by geographic locality. This page is for informational purposes only.