How Much Does a Colonoscopy Cost?

Preventative screening tests are key to detecting some cancers early, which can improve your chances of surviving the disease. Such tests include mammograms, chest X-rays, annual blood work, and colonoscopies. 

Although those tests are critical, they often rack up many fees. For example, a study published in 2022 found that the average colonoscopy cost in the U.S. is $2,125, with nearly $80 in out-of-pocket fees.

The American Cancer Society (ACS) estimated 106,970 new cases of colon cancer and 46,050 cases of rectal cancer in 2023. The ACS expected colorectal cancer to cause nearly 52,550 deaths in the same year.

Since the mid-1990s, colorectal cancer rates have increased among people younger than 50. In particular, in 2020, the death of Chadwick Boseman hit many people—specifically Black families—hard. Grief stemmed from the sorrow of losing a Black American icon, and the light shined on the increase in cases and mortality rates of colorectal cancer for people under 50.

Preventative screening tests are critical, but how can you get that screening without incurring a huge bill? Read on to learn how to minimize the cost of a colonoscopy, whether you are insured or not.

What Is a Colonoscopy?

"The purpose of doing a colonoscopy is to be able to see inside the colon and be able to biopsy or take out polyps from inside the colon," Lisa Ganjhu, DO, a gastroenterology specialist in New York, told Health. Polyps are growths of excess tissue in the large intestine or colon. Most polyps are non-cancerous.

"Some types of polyps can turn into colon cancer. Removing polyps reduces the risk of them turning into colon cancer. The colonoscopy is used for colon cancer screening and for other diagnostic indications," said Dr. Ganjhu.

A gastroenterologist passes a flexible tube, or a colonoscope, into the rectum during the colonoscopy procedure. The tube has a light source, air source, a suction port, and a channel that allows the passage of instruments—such as biopsy forceps, snares, and brushes.

The light and air source allow the gastroenterologist to see inside the colon. The suction port lets them clean or suction out liquid from the colon.

Mandated Coverage for Colonoscopy Costs

The Centers for Disease Control and Prevention (CDC) advises people aged 45 and older to begin regular colorectal cancer screenings. People with a high risk of developing the disease may need earlier screenings.

The Affordable Care Act (ACA) mandates that private insurers and Medicare cover the costs of colorectal cancer screening tests since the United States Preventive Services Task Force (USPSTF) advises them. The ACA specifies that insurers do not charge people out-of-pocket costs, such as copays or deductibles, for those tests.

Coverage Under Age 45

Having a colonoscopy done with the approval of your health insurance provider depends mainly on your medical history. People younger than 45 might need to receive a colonoscopy if they have risk factors like:

• A family history of colon cancer or polyps
• A personal history of colon cancer or polyps
• A personal history of inflammatory bowel disease
• A personal history of radiation to the abdomen or pelvic area to treat cancer

For example, Brett C., a management consultant in Atlanta, told Health that he had his first colonoscopy at age 36. Brett started preventative screenings early because both of his parents were diagnosed with colon cancer and died within three months of each other. Subsequent screenings for both Brett and his brothers found precancerous polyps.

Your medical history will decide whether you need a colon screening before age 45 and if your insurance will fully cover it. 

Advocating for your health and having a trusted healthcare provider is crucial. You may need to "recruit [a gastroenterologist] to assist you in writing a letter of medical necessity," Christin Sonneborn, a patient navigator at Colorectal Cancer Alliance, told Health.

Screening vs. Diagnostic Colonoscopy

A screening colonoscopy is done based on a recommended schedule, not to evaluate colon cancer symptoms.

According to Dr. Ganjhu, healthcare providers use a diagnostic colonoscopy for people with "alarming symptoms," such as:

• Bleeding
• A change in bowel habits or stool caliber
• Diarrhea
• Constipation
• Abdominal pain
• Weight loss

The payment guidelines for a diagnostic colonoscopy may differ from that of a colonoscopy done as part of preventative care.

Surprise Colonoscopy Costs

"Guaranteed coverage" can be a slippery concept, and surprise bills are common. Many insurers use the loophole in how they define "screening" tests to avoid paying for the procedure. 

Here are a few reasons you might get an unexpected bill for your screening colonoscopy and what you can do to avoid surprise charges.

Out-of-Network Healthcare Providers

Be aware of coverage for all healthcare providers involved in the colonoscopy. In other words, it's not just the gastroenterologist who gets paid.

"Regrettably, it's not uncommon for anesthesiologists to be out-of-network, and the bill you get for their work can be awfully surprising," Sonneborn told Health. "Always ask ahead of time about the [healthcare providers] who will participate in your procedure and request that they be in-network. If you aren't given the choice of using an in-network anesthesiologist, this is through no fault of your own and can be appealed with your insurance."

Bowel Prep Kit

You may be responsible for paying for your bowel prep kit and other services. Obtain the healthcare provider's current procedural terminology (CPT) code for your colonoscopy to get accurate pricing and avoid unexpected costs. 

Questions that you should ask your health insurance carrier before your colonoscopy include:

• Are there any out-of-pocket costs for the CPT code used by the healthcare provider?
• Is the anesthesiologist being used in the network?
• Will I save money by scheduling the procedure at an ambulatory surgery center (ASC) versus a hospital outpatient department (HOPD)?

Complications

Another surprising twist: The insurer might initially approve coverage for a colonoscopy, then reverse their decision if screening detects precancerous polyps. The policy may vary with different payers.

Brett, who had private insurance, shared that his "biggest surprise bill was when my [healthcare provider] punctured my colon during my colonoscopy, and I spent three days in the hospital. I had to pay for a portion of those costs, too. Keep in mind that I worked for a Fortune 100 company, and I'd selected the best health insurance options available."

The Centers for Medicare & Medicaid Services (CMS) states that "polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure."

The screening colonoscopy guidelines differ if you are a Medicare beneficiary. The screening colonoscopy becomes a diagnostic colonoscopy, and you will be responsible for a copay if the healthcare provider finds a polyp.

You can access the Procedure Price Lookup Tool to compare payments and copays for colonoscopies and other medical procedures performed in ASCs and Hospital Outpatient Departments (HOPDs).

"Recent Medicare guidelines encourage coding and billing of colonoscopies based on intent, which means that if your colonoscopy was scheduled as a preventive screening, it should remain as such, whether it finds and removes polyps or not," said Sonneborn.

This can be frustrating, as "no one goes into a routine screening expecting bad news. If a patient is being responsible and following through with preventative screening, they shouldn't be penalized with a surprise bill because polyps were found," added Sonneborn.

Paying for the Cost of a Colonoscopy Without Insurance

For people who are uninsured, colon cancer screening is equally important; it's just less accessible. You can consult the Healthcare Bluebook to compare colonoscopy costs in their area.

There are options for getting a free or low-cost colonoscopy, including:

• The New York State Cancer Services Program (CSP) provides colon cancer screening to uninsured people in New York aged 50–75.
• The Colorectal Cancer Alliance is a resource for accessing a low-cost colonoscopy or a no-cost at-home fecal immunochemical test (FIT).
• ColonoscopyAssist is a nationwide organization that provides low-cost colonoscopies in most U.S. cities.

Knowing your medical status can be lifesaving. Screenings like a colonoscopy may not seem a priority if you are juggling daily finances and are in great health. Still, the overall cost of cancer treatment might make you think twice about delaying screening.

A Quick Review

A colonoscopy can detect colorectal cancer early, which can help maximize your survival chances if you have the disease. Experts recommend that most people start colorectal cancer screening at 45. High-risk groups might need to begin screening even earlier than that.

Make sure that all healthcare providers, including anesthesiologists, are in-network. Advocating for yourself, asking questions as necessary, and being aware of your options, whether you are insured or not, can help minimize your colonoscopy costs.