Colonoscopy price: Medicare anchor and facility lever
Anchor for Colonoscopy - CPT 45378
$172.49
Nonfacility PFS $378.46; facility professional PFS $172.49.
Diagnostic colonoscopy is priced in layers, and the code itself can change while you are sedated. CPT 45378 is the look-only procedure. If tissue is sampled or a polyp is removed, the procedure is billed under a different code, and for a screening visit Medicare cost sharing changes too. That is why this page pairs the anchor with the codes it can turn into.
CPT code
45378
Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
CPT 45378 is diagnostic colonoscopy. Biopsy is 45380, polyp removal by snare is 45385, and screening in a high-risk individual may use HCPCS G0105. The anchor changes with the code actually billed.
The codes this visit can be billed under
| CPT | PFS office or global | PFS facility (professional) | Global period | Hospital single-service APC | Minimum Medicare copay at hospital |
|---|---|---|---|---|---|
| 45378 (this page) | $378.46 | $172.49 | 0 days | $950.10 (APC 5311) | $190.02 |
| 45380 | $477.34 | $185.64 | 0 days | $1,222.56 (APC 5312) | $244.52 |
| 45385 | $500.01 | $233.13 | 0 days | $1,222.56 (APC 5312) | $244.52 |
| 88305 | $69.02 | $69.02 | not a surgical global | $53.24 (APC 5671) | $10.65 |
The CY2026 Michigan Locality 01 anchors move with the code: 45378 is $378.46 nonfacility and $172.49 facility; with biopsy (45380) the facility professional anchor rises to $185.64; with snare polyp removal (45385) it is $233.13. In a hospital, 45378 maps to APC 5311 at $950.10, while 45380 and 45385 move to APC 5312 at $1,222.56.
Medicare.gov describes the screening rule separately from this diagnostic code: a screening colonoscopy is covered with nothing to pay when the provider accepts assignment, and if a polyp or tissue is removed during it, the patient pays 15 percent of the approved amount for the provider and a 15 percent facility coinsurance in a hospital or ASC, with no Part B deductible. Ask how the visit will be coded before it happens.
For a diagnostic colonoscopy billed in a hospital, the minimum unadjusted Medicare facility copayment for 45378 is $190.02, and the endoscopist's coinsurance is figured on $172.49. The CMS fee schedule lists a 0-day global period for 45378, so a separate visit to discuss results is billed as its own service.
Inside and outside the 45378 anchor
Covered by the anchor
- Endoscopist professional fee for the diagnostic procedure (PFS anchor below)
- Use of the endoscopy suite and standard recovery monitoring in the facility payment
Billed outside it
- Anesthesia or sedation billed separately (often CPT 45378 with anesthesia codes 00811 or 00812, or moderate sedation codes)
- Pathology when a biopsy or polyp is taken (for example 88305)
- Bowel prep supplies
- The pre-procedure visit and follow-up visit when billed separately
Why prices vary for CPT 45378
Colonoscopy has three price layers that move independently: the endoscopist professional fee, the facility fee (hospital OPPS versus ASC versus office), and anesthesia and pathology when they apply. Medicare pays the professional fee under the PFS at a lower facility rate when the work is done in a facility, because the facility bears the overhead. The facility fee is the largest lever. A hospital outpatient department is paid under OPPS, an ambulatory surgery center under the ASC system at a lower rate, and an office endoscopy suite under the PFS nonfacility amount with no separate facility bill.
Ask where the procedure will be performed (hospital, ASC, or office), whether anesthesia will bill separately, and whether pathology is likely. Get the all-in cash quote for each layer in writing.
Questions specific to Colonoscopy
- Will this be billed as a screening or a diagnostic colonoscopy, and under which code?
- If a biopsy or polyp removal happens, which code replaces 45378 and what is the written price for it?
- Who provides sedation or anesthesia, and do they bill separately?
- Which pathology lab receives tissue, and is its fee inside the quote?
Colonoscopy: billing questions
Why did my colonoscopy bill a different code than the quote?
The code follows what was done. A look-only procedure is 45378; a biopsy makes it 45380 and snare polyp removal makes it 45385. Each carries a different Medicare anchor, and in a hospital the facility APC moves up as well. Ask in advance for the written price of each possible code.
What does Medicare charge if a polyp is removed during a screening?
Medicare.gov says that when a polyp or tissue is removed during a screening colonoscopy, you pay 15 percent of the Medicare-approved amount for the provider's services and a 15 percent coinsurance to the hospital or surgery center, and the Part B deductible does not apply.
Is the anesthesia fee part of the colonoscopy anchor?
No. The anchor covers the endoscopist's professional service under the fee schedule. Anesthesia, when used, is billed under its own anesthesia codes by the anesthesia provider, and pathology is a separate bill when tissue is examined.
What is G0121?
G0121 is the HCPCS code Medicare uses for a screening colonoscopy for a person not at high risk. In the CY2026 OPPS Addendum B it maps to the same hospital APC as 45378 but with a $0.00 copayment, consistent with Medicare covering screening colonoscopy with no cost sharing when the provider accepts assignment.