Colonoscopy With Polyp Removal Cost
Colonoscopy w/lesion removal
$1,446Hospital 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 polyp removal. 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 polyp removal 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 $276.56.
How CMS prices CPT 45385
Work is about 30% of the office total RVU; practice expense is about 67%. 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: $500.01. Hospital (facility) physician rate: $223.45.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible — about $100 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 Polyp Removal?
This colonoscopy code means the physician found one or more polyps and removed them using a snare, a thin wire loop that lassoes the polyp and cuts it free, often with cauterizing current. Snare removal is the standard technique for larger polyps and is the step that gives colonoscopy its cancer-preventing power, since removing precancerous polyps stops them from progressing. The patient experience is unchanged from any colonoscopy: prep, IV sedation, a 20 to 45 minute procedure, and same-day discharge.
What Affects the Cost
- –Every removed polyp goes to pathology in its own container, and each container is a separate lab charge.
- –The physician fee for snare polypectomy is the highest of the common colonoscopy codes, above both biopsy (45380) and diagnostic (45378).
- –Facility setting remains the biggest overall cost lever, with hospitals charging far more than endoscopy centers.
- –Separately billed anesthesia adds its own professional fee.
- –Large or complex polyps may require advanced removal techniques or clips to close the site, which can add device and procedure charges.
- –Finding polyps shortens your recommended interval to the next colonoscopy, pulling that future cost closer.
How It Is Billed
CPT 45385 covers snare removal of polyps, however many are removed by that technique, in one physician fee; pathology bills per specimen separately. If some lesions were snared and others sampled with forceps, both 45385 and 45380 can appear on the claim with payment adjustments for the overlap. This is the classic scenario where a free screening produces a bill: the procedure code changed because polyps were found, even though you went in for a routine screening.
Insurance & Coverage Notes
Under ACA preventive rules, commercial plans must waive cost sharing when polyp removal happens during a screening colonoscopy; if you get billed for the procedure itself after a routine screening, challenge the coding. Medicare handles it differently: polyp removal converts the claim from a fully covered screening to a procedure with coinsurance, currently being phased down to zero over several years. The pathology charges for analyzing the polyps fall outside the preventive benefit everywhere, so a lab bill after a clean screening with polypectomy is normal, not an error.
Questions to Ask Before Booking
- 1.If polyps are removed during my screening, will the procedure still be billed with the preventive modifier at no cost share to me?
- 2.What will the pathology lab charge per polyp, and is that lab in network?
- 3.For Medicare: what percentage coinsurance applies to polyp removal during a screening this year?
- 4.If you find a large polyp needing a special technique or clips, how does the cost change?
- 5.How soon will I need my next colonoscopy if polyps are found, and will that one count as screening or surveillance for coverage?
Colonoscopy With Polyp Removal (CPT 45385): questions
The 2026 national Medicare physician rate for CPT 45385 is $500.01 in an office and $223.45 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 45385 that produces an office rate of $500.01 and a hospital physician rate of $223.45 (a $276.56 gap). The hospital’s own facility charge is extra and often larger than this entire physician line.
This colonoscopy code means the physician found one or more polyps and removed them using a snare, a thin wire loop that lassoes the polyp and cuts it free, often with cauterizing current. Snare removal is the standard technique for larger polyps and is the step that gives colonoscopy its cancer-preventing power, since removing precancerous polyps stops them from progressing. The patient experience is unchanged from any colonoscopy: prep, IV sedation, a 20 to 45 minute procedure, and same-day discharge. CMS bills it as “Colonoscopy w/lesion removal.”
Not on its own. $500.01 is the physician allowed amount. Medicare also pays the facility, which takes the total to about $1,446 in a hospital outpatient department or about $880 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.