Questions to ask billing before your procedure

The checklist

Code and setting

1. What CPT code was ordered, and what CPT code will be billed if nothing changes?
2. Is contrast, tomosynthesis, Doppler, or any add-on code expected? Which codes?
3. What is the exact setting: hospital outpatient department, ambulatory surgery center, independent imaging center, or physician office? Facility name and address?
4. Does your practice perform the same code in another setting? What is the price there?

Price layers

1. What is the all-in cash price for that CPT code in that setting?
2. Is the professional fee included, or will the radiologist, cardiologist, or endoscopist bill separately? Amount?
3. Is the facility fee included? Amount, or not applicable in this setting?
4. For endoscopy: is anesthesia or sedation included, likely, or billed separately? Which group bills it? The Medicare formula behind an anesthesia charge is worked through in how an anesthesia bill is calculated.
5. For endoscopy or biopsy: is pathology included, likely, or billed separately? Which lab or group bills it?
6. Are supplies, contrast material, or recovery charged separately?

Day-of-change

1. If the plan changes on the day, what new code will be billed? (Example: diagnostic colonoscopy 45378 becomes biopsy 45380.)
2. What will the all-in price be under the changed code?
3. Who will tell me about the change, and will the new charge be reflected in a revised written estimate?

Written confirmation

1. Can you send the price in writing with CPT code, setting, and inclusions listed?
2. How long is the quote valid, and who provided it (name, department, date)?
3. If I am uninsured or self-pay, will this written price be my Good Faith Estimate?
4. What number do I call if the final bill does not match the written price?
5. If I cannot pay that price, do you have a financial assistance policy, and can I apply before the service?

That last question has a federal program behind it at a tax-exempt hospital: a written financial assistance policy the hospital must maintain under IRS Section 501(r), which caps what an eligible patient can be charged and sets a 240 day application window. The full explanation, including how to read the policy's plain language summary and apply, is in Hospital financial assistance: how to ask for charity care before you pay.

Write the answers here

Item	Answer
CPT code ordered / billed
Setting and facility
Professional fee
Facility fee
Anesthesia
Pathology
All-in price and validity date
Day-of-change code and price
Quoted by (name / date)

Red flags that mean ask again

• A quote without a CPT code.
• A facility-only quote presented as the total price.
• "Anesthesia and pathology will be whatever they bill" with no group name or range for a procedure where they commonly apply.
• No answer to the day-of-change question for a colonoscopy or EGD.
• A verbal-only quote the facility will not put in writing.

After the service

Compare the bill line by line with your written price. Match each CPT code, setting, and layer. If an uninsured or self-pay bill exceeds the Good Faith Estimate by $400 or more for the same provider, see the Good Faith Estimate guide for the dispute window. For any mismatch, call the billing number you wrote down and reference the written quote by date and who provided it. The full after service procedure is in How to check an itemized medical bill for errors before you pay. One question belongs on this checklist before any of that: which dollars will pay the confirmed price? If you hold an HSA or a health FSA, the eligibility, timing, and leftover rules in HSA or FSA: paying for care with pre-tax dollars decide the order, and one of the two accounts can take unspent money back at the end of the plan year.

How to run the call, step by step

1. Before you dial, open the procedure page for your test on this site and note the CPT code, the code variants, and the Medicare anchor. For example, the colonoscopy page and the upper endoscopy page each list the day-of-change codes that most often surprise patients.
2. Start the call with setting and code, not with price. Confirm where the service will happen and which code will be billed if nothing changes. Price questions asked before those two facts are settled produce numbers for the wrong service.
3. Walk the price layers in order: professional, facility, anesthesia, pathology, supplies. Mark each one included, separate, or not applicable, and write the amount or the billing group beside it.
4. Ask the day-of-change question out loud, even if it feels hypothetical. For endoscopy it is the difference between the diagnostic code you scheduled and a biopsy code you did not.
5. Close by asking for the written version and the callback number. Read your table back to the person who quoted it. Errors are cheapest to fix while you are both looking at the same list.

A short worked example of the checklist doing its job

Suppose the ordering office gives you one CPT code and the facility offers the same code in two settings. Your checklist now has two columns to fill instead of one price to accept. In the hospital outpatient column the facility layer is an OPPS payment and the professional fee is separate; in the imaging center or office column the same code is usually one global or nonfacility amount. The Price Anchor Explorer shows that split with the verified Medicare anchors for your code, so you can see which layer is missing from any quote that looks unusually low.

Nothing in that comparison requires a made-up cash price. It requires the same code, the same layers, and both answers in writing. That is the whole method, and it is why this site publishes anchors and questions instead of ranges it cannot verify. See How Prices Work for the two payment systems behind the columns.

Check the hospital price transparency posting before you call

If your setting is a hospital or a hospital outpatient department, do one check before you dial the billing office. Since January 1, 2021, hospitals in the United States have had to make their standard charges public, free of charge, in a consumer-friendly display. That display covers services that can be scheduled in advance, which CMS calls shoppable services. CMS guidance for consumers says hospitals must post standard charges for at least 300 shoppable services, with a description of each service and the other services the hospital customarily provides with it. The posted charges include the discounted cash price, which is the amount the hospital accepts from a patient who pays in cash, alongside the charges the hospital has negotiated with insurance plans. Many of the procedures on this site, including imaging, laboratory tests, outpatient visits, and a colonoscopy, are the kind of planned service that can appear in that display.

Use the posting to prepare the call, not to replace it. Search the hospital display, or the price estimator tool the hospital offers instead, by the procedure name and by the CPT code you wrote at the top of this checklist. Write down three things: the cash price shown for that code, the setting and hospital location the price belongs to, and any bundled items the display lists as customarily provided with the service. Then compare that result with the Medicare anchor for the same code in the Price Anchor Explorer. The anchor and the posting answer different questions. The anchor shows the Medicare payment basis for the code and setting. The posting shows the hospital standard charges for that location. A large gap between the two is not an answer by itself, but it is a precise question for the billing office: which layer explains the gap, and is that layer inside the all-in price you are about to confirm in writing?

Bring the posting into the call in plain language. Say: "Your website lists a discounted cash price for this CPT code in this setting. Is that the facility layer of my all-in price, and what else will be billed on top of it?" Ask which layers the posted price does not cover, starting with the professional fee, anesthesia, and pathology, because those groups often bill separately from the hospital. Ask whether the estimator result, if you used one, was a standard charge or an estimate based on insurance details you entered, since only the written confirmation from billing settles your own price. If billing gives you a different cash price on the phone, ask what changed: a different code, a different setting, a different location of the same hospital system, or an added service. Write the reason next to both figures instead of crossing one out, so the final bill can be checked against both records.

If you cannot find the posting, ask billing where it is. Ask for the page or tool name, ask whether your code is listed as a shoppable service, and ask the billing office to walk you to the line for your code and setting while you are on the phone. If the service will happen at an imaging center, an ambulatory surgery center, or a physician office instead of a hospital, the hospital posting will not cover that setting, and that limit is itself useful information. In that case go back to the checklist questions for that setting and get the all-in cash price in writing from the facility that will actually bill you. In every setting the rule stays the same: a posted standard charge is a starting point for questions, and a written all-in price for the exact code in the exact setting is the document you rely on. Confirm your price in writing before service. The complete procedure for finding the posting, reading its five standard charge types, and comparing hospitals on the same code is in How to use a hospital's published prices.

Source: Centers for Medicare and Medicaid Services, Hospital Price Transparency consumer guidance, How To Get the Most Out Of Hospital Price Transparency, checked October 15, 2026.

Ask about each billing group separately: who bills you, and are they in your network?

The price layers on the checklist above are not only amounts. Each layer can belong to a different organization, with its own bill, billing phone number, and contract with your health plan. The facility can be one organization, the clinician who performs or reads the service a second, anesthesia a third group, and pathology or laboratory work a fourth. An amount with no group name cannot be checked, or matched when its bill arrives weeks after the others. So for every layer, add three questions: "What is the exact name of the group that bills this layer? What phone number do I call about that bill? If I use insurance, is that group in network for my specific plan, not just for my insurer in general?" Write each answer in the Answer column of the table above, beside the layer it belongs to.

An in-network facility does not settle the network status of the groups inside it. HealthCare.gov defines balance billing as billing you for the difference between a provider charge and the allowed amount, with the example of a $100 charge and a $70 allowed amount leaving a $30 difference. That difference is the risk an out-of-network layer can carry on an otherwise in-network visit. Federal protection narrows that risk. The No Surprises Act, in effect since January 1, 2022, applies to most types of health insurance, and the Centers for Medicare and Medicaid Services (CMS) consumer pages say it protects patients from unexpected out-of-network bills for non-emergency care related to a visit to an in-network hospital, hospital outpatient department, or ambulatory surgical center. CMS guidance adds that certain services at an in-network facility, including anesthesia, pathology, radiology, and laboratory services, cannot balance bill you, and those providers may not ask you to give up that protection. Read that protection as a backstop, not as a reason to skip the questions: it does not name your price in advance, and it does not help you match a bill to a group you never recorded. Ask too whether the procedure needs prior authorization and who requests it, as the prior authorization guide explains.

If you are uninsured or paying for yourself, ask the same question in a different form: "Will this group send me a separate bill, and is its charge inside the written price you just gave me, or inside my Good Faith Estimate?" A labelled hypothetical illustration shows the arithmetic to run on your own answers. The four figures here are round numbers invented only to show the addition. They are not a price for any procedure. Suppose your written answers are a $900 facility layer, a $300 professional layer, a $200 anesthesia layer, and a $100 pathology layer. Adding them, $900 plus $300 plus $200 plus $100, gives $1,500. Now suppose the anesthesia answer is missing. The known subtotal is $900 plus $300 plus $100, which is $1,300, and the honest total is $1,300 plus one layer still unknown, not $1,300. A total with a silent layer is a partial answer, however confident it sounds.

Close with a read-back, group by group: "So the facility bill comes from this facility, the professional bill from this group, anesthesia from this group, and pathology from this lab. Is anyone else expected to bill me for this procedure?" That last question gives billing one clear chance to name a group the checklist did not reach. If the office cannot name a group, write "group not yet named" beside that layer instead of leaving it blank, and ask who can name it and by when. A blank line looks finished later. A line marked as still open shows which question was never answered. Confirm your price in writing before service, and keep the group list with it: the price says what you agreed to, and the group list says who agreed to it.

Sources for this section: Centers for Medicare and Medicaid Services, Medical bill rights and No Surprises Act consumer pages, at cms.gov/nosurprises/consumers, and HealthCare.gov, Balance billing glossary definition, checked October 17, 2026.

Insured callers get more out of the checklist with their plan numbers in hand: our deductible versus out-of-pocket maximum guide shows how to estimate your share from the allowed amount, and once the claim is processed, reading the explanation of benefits tells you whether the bill matches what the plan decided.

For a scheduled delivery the questions are arranged by billing layer in the hospital birth bill guide, and for a surgical procedure the choice of facility has its own question set in the surgery center comparison.

Billing call questions

Sources for the checklist

Centers for Medicare and Medicaid Services, Hospital Price Transparency consumer guidance, How To Get the Most Out Of Hospital Price Transparency, at cms.gov/priorities/key-initiatives/hospital-price-transparency/consumers, checked October 15, 2026. Centers for Medicare and Medicaid Services, Medical bill rights and No Surprises Act consumer pages, at cms.gov/nosurprises/consumers, checked October 17, 2026. HealthCare.gov, Balance billing glossary definition, at healthcare.gov/glossary/balance-billing, checked October 17, 2026.

Related: How to ask for the cash price - Price Anchor Explorer - How Prices Work.