Colonoscopy With Biopsy Cost
Colonoscopy and biopsy
$1,400Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
National Medicare physician rate (2026)
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.
Choosing a surgery centre over a hospital saves about $566 on the Medicare allowed amount for colonoscopy with biopsy. Ask whether your procedure can be done at an ambulatory surgery centre.
This is Medicare's separate payment to the facility on top of the physician's fee. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Get the rate for your ZIP
CMS adjusts this CPT by locality. A five-digit ZIP is enough — no account, no insurance card.
What colonoscopy with biopsy costs at hospitals near you
Everything above is a national average. The hospital you pick in your area moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. For this code the office and hospital physician lines differ by $302.28.
How CMS prices CPT 45380
Work is about 24% of the office total RVU; practice expense is about 73%. Localities with a high PE GPCI move this code more when practice expense is a large share.
Office vs hospital for this code
Office (non-facility) physician rate: $479.97. Hospital (facility) physician rate: $177.69.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible — about $96 for the office physician fee, before any Medigap coverage. That coinsurance does not include a hospital facility fee.
Labeled private-plan and cash ranges on this page are arithmetic multiples of Medicare, not negotiated quotes. Ask the billing office for the CPT code, the site of service, and a good-faith estimate.
What Is Colonoscopy With Biopsy?
This is a colonoscopy during which the physician passes small forceps through the scope to take one or more tissue samples, called cold biopsies, from the colon lining. It is used when the doctor sees inflammation, an unusual patch, or needs to test for conditions like microscopic colitis, which can only be diagnosed under a microscope. From the patient's perspective it is identical to any colonoscopy: prep the day before, IV sedation, a 20 to 45 minute exam, and home the same day.
What Affects the Cost
- –Every biopsy container sent to the lab is billed separately by pathology, and workups for conditions like microscopic colitis involve samples from multiple colon segments.
- –The physician fee for 45380 is higher than the diagnostic-only code 45378 because sampling was performed.
- –Facility choice between hospital outpatient and freestanding endoscopy center remains the largest single price driver.
- –Separate anesthesia billing applies when a dedicated provider administers sedation.
- –If a polyp is also removed by snare during the same exam, an additional code (45385) is billed alongside this one.
How It Is Billed
CPT 45380 covers biopsy sampling with cold forceps, whether one sample or many, in a single physician fee; the pathology lab then bills per specimen jar, which is where multi-sample exams get expensive. It is distinct from 45385, which is removal of polyps with a snare, and both codes can legitimately appear on the same claim if both techniques were used on different lesions. Physician, facility, anesthesia, and pathology typically produce four separate bills.
Insurance & Coverage Notes
If your colonoscopy started as a routine screening and the doctor took biopsies, federal ACA rules require most commercial plans to still treat it as screening with no cost sharing; Medicare works differently and applies coinsurance to the procedure once tissue is removed, though its share has been shrinking year by year under a phase-out schedule. If the exam was ordered for symptoms, it is diagnostic from the start and normal cost sharing applies. The pathology bill is never part of the free screening benefit, so expect to owe something for the lab work.
Questions to Ask Before Booking
- 1.Was my colonoscopy ordered as a screening or for symptoms, and how will biopsies affect what I owe under my specific plan?
- 2.How many specimen jars might be sent to pathology and what is the charge per jar?
- 3.Is the pathology lab in my insurance network?
- 4.If you also remove a polyp with a snare, will both procedure codes be billed and what does that total?
- 5.For Medicare patients: what coinsurance applies this year when a screening turns into a biopsy?
Colonoscopy With Biopsy (CPT 45380): questions
The 2026 national Medicare physician rate for CPT 45380 is $479.97 in an office and $177.69 in a hospital. Enter a ZIP code to apply the geographic adjustment for your locality.
Medicare uses a different practice-expense RVU in a facility. For CPT 45380 that produces an office rate of $479.97 and a hospital physician rate of $177.69 (a $302.28 gap). The hospital’s own facility charge is extra and often larger than this entire physician line.
This is a colonoscopy during which the physician passes small forceps through the scope to take one or more tissue samples, called cold biopsies, from the colon lining. It is used when the doctor sees inflammation, an unusual patch, or needs to test for conditions like microscopic colitis, which can only be diagnosed under a microscope. From the patient's perspective it is identical to any colonoscopy: prep the day before, IV sedation, a 20 to 45 minute exam, and home the same day. CMS bills it as “Colonoscopy and biopsy.”
Not on its own. $479.97 is the physician allowed amount. Medicare also pays the facility, which takes the total to about $1,400 in a hospital outpatient department or about $834 at an ambulatory surgery centre. Anesthesia, pathology and imaging interpretation billed under other codes are separate again. Private-plan allowed amounts are often higher than Medicare; your deductible and coinsurance still apply.
For cash-pay surgery shopping, use this CPT as the Medicare floor when you compare written quotes. How cash-price shopping works.