Colonoscopy types
Bills
Colon cancer screening coverage laws
The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.
Page 1 of 2
WHAT TO EXPECT
Paying for your colonoscopy
By specialists, for patients.
Under the Aordable Care Act, you can get certain preventive health care tests done for free.
Colonoscopy is one of these tests. It is often free, but there are some cases in which patients must pay part
of the cost. Congress recently passed a new law that will stop unexpected bills for screening colonoscopy
gradually between 2022 and 2030, but for now this resource contains the most current information.
By answering a few questions, you can gure out what to expect to pay for your colonoscopy.
Talk to your doctor’s billing team or your health plan if you have more questions.
To learn more, search online for:
• The American Cancer Society: Colorectal Cancer Early Detection Screening Coverage Laws
• The American Gastroenterological Association: Patient Cost Sharing for Screening Colonoscopy
• Medpage Today: General Gastroenterology
You may get up to 4 bills for your colonoscopy.
1. One from the doctor who did your colonoscopy.
2. One from the place where you had your colonoscopy.
3. One from the anesthesia care team, if you get sedation.
4. One from the pathology lab, if a biopsy or polyp is removed.
* African Americans should begin screenings at age 45. Some insurers allow
screenings beginning at age 45 for everyone based on new recommendations
from the U.S. Preventative Services Task Force.
Screening Colonoscopy:
A test if you are at average-risk
for colon cancer.
• Done every ten years for anyone over
age 50* to look for (and remove, if
needed) colon polyps.
• If polyps are not removed, the
colonoscopy and sedation are covered
100% by health insurance.
NORMAL
Diagnostic Colonoscopy:
A test if you are higher-risk
for colon cancer.
• Not fully covered (meaning you may have
to pay some of the costs).
• Will remove colon polyps, look for
inammation in patients with GI symptoms
or who have Crohn’s disease or ulcerative
colitis, or look for and treat bleeding.
HIGHER
If you have
private insurance
If you have private insurance and
were charged for a colonoscopy,
you can appeal the claim.
To learn more about appealing
your colonoscopy charges to your
private insurance, talk to your
doctor’s billing ofce or read more
on How To Appeal a Rejected
Claim on WebMD.com.
February 2021 ©AGA 2021
The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.
Page 2 of 2
February 2021 ©AGA 2021
• Having GI symptoms right now.
• Have had colon polyps.
• Have Crohn’s disease or
ulcerative colitis.
• Have a direct family member.
with colon polyps or colon
cancer.
• You will get a SCREENING
COLONOSCOPY.*
• Your insurance should cover
100% of the costs, so you will
not need to pay.
• If your doctor removes a polyp
during the test, it becomes a
DIAGNOSTIC COLONOSCOPY.
This means your insurance may
not cover the cost. Your care
team will let you know after if
they find any polyps.
NORMAL
Are you part of any
of these groups?
• You will get a DIAGNOSTIC
COLONOSCOPY.
• Your insurance may not
cover the full cost and you
will need to pay part of the
cost out of pocket.
HIGHER
• I am 50* years of age or older.
• I have no history of GI disease,
colon polyps or colon cancer.
• I have not had a colonoscopy
within the last 10 years.
Are all of the below
statements true?
Have you had a positive
stool test that found
hidden blood when
screening for colon cancer
in the last 12 months?
*45 years or older for African Americans. Some insurers
allow screenings beginning at age 45 for everyone based
on new recommendations from the U.S. Preventative
Services Task Force.
No
No
No
Yes
Yes
Yes
(FIT, FOBT, Cologuard
®
, etc.)
You are
HIGHER RISK
for colon cancer
You are
AVERAGE RISK
for colon cancer.
What you may have to pay
Start here
By specialists, for patients.
