Medicare Colonoscopy Coverage: What You'll Pay in 2026

Medicare's polyp-removal coinsurance is exactly the kind of rule nobody explains beforehand - a screening that's supposed to be free can quietly become a bill mid-procedure. Here's the rule, before you're the one finding out the hard way.

Medicare covers colonoscopies under Part B. The rules have one important nuance that no commercial insurance plan shares: when a polyp is removed during a screening colonoscopy, Medicare applies a coinsurance charge. This is a statutory requirement being phased out - it drops to 0% by 2030 - but in 2026 it applies at 15% of the physician fee.

What Medicare Covers

Source: Medicare.gov - Colonoscopy Coverage

Screening colonoscopy (preventive)

Medicare covers screening colonoscopies for all Medicare beneficiaries at no cost sharing when no tissue is removed:

• Average risk: Once every 10 years
• High risk (prior adenomatous polyps, inflammatory bowel disease, family history): Once every 4 years
• No minimum age: Unlike commercial ACA plans that start at 45, Medicare imposes no lower age limit for its own beneficiaries
• Cost: $0 when no polyp is found or removed

When a polyp is removed

This is what makes Medicare different from commercial coverage.

Removing a polyp during a Medicare screening colonoscopy triggers a coinsurance on the gastroenterologist's physician fee. The facility fee remains at $0. The coinsurance rate is set by statute and phases to zero:

• 2026: 15% of the Medicare-approved physician fee
• 2027–2029: 10%
• 2030+: 0%

The Medicare-approved physician fee for a colonoscopy with polypectomy typically ranges from $150–$300. At 15% coinsurance, your actual out-of-pocket is roughly $22–$45 - not a large amount, but an unexpected one if you assumed the procedure was entirely free.

This phase-down is mandated by the Consolidated Appropriations Act and will eliminate the coinsurance entirely by 2030. No action is required on your part - the rate adjusts automatically at each statutory threshold.

Follow-up after a positive stool test: $0 since 2022

If your physician ordered a colonoscopy because a Cologuard, FIT, or FOBT result was positive, Medicare covers the follow-up colonoscopy as a preventive service - $0 cost sharing - for plan years beginning on or after May 31, 2022.

Prior to 2022, Medicare classified this follow-up as diagnostic, triggering the Part B deductible and 20% coinsurance. That changed with the Consolidated Appropriations Act. If you had this follow-up colonoscopy after May 31, 2022 and were charged diagnostic cost sharing, you can dispute the classification.

Diagnostic colonoscopy

A colonoscopy ordered to investigate specific symptoms - rectal bleeding, change in bowel habits, abdominal pain - is a diagnostic procedure under Medicare, not preventive. It is covered under Part B subject to:

• The Part B deductible ($257 in 2026)
• 20% coinsurance after the deductible is met

If you have a Medicare Supplement (Medigap) plan, your supplement covers the Part B coinsurance and usually the deductible depending on plan type.

The Four Bills You'll Receive

A Medicare colonoscopy still generates separate bills from separate providers:

If you have a Medigap plan, it typically covers the Part B coinsurance on anesthesia and pathology as well.

Medicare Advantage (Part C)

If you are enrolled in a Medicare Advantage plan, your colonoscopy benefits must meet or exceed traditional Medicare's standard - your plan cannot provide worse screening colonoscopy coverage than traditional Medicare Part B.

However, MA plans may require in-network providers, prior authorization for diagnostic colonoscopies, and apply different copay structures for diagnostic services. Check your plan's Evidence of Coverage for specifics.

How to Verify Your Medicare Colonoscopy Claim

After the procedure, review your Medicare Summary Notice (MSN) - Medicare's equivalent of an Explanation of Benefits. Look for:

1. Procedure type: Screening or diagnostic? Confirm with your physician's coding.
2. Amount Medicare approved: Basis for your cost calculation (not the billed amount)
3. Amount Medicare paid: Should be 100% for screening with no polyp removed
4. Your responsibility: Should be $0 for screening with no polyp; ~15% of physician fee if polyp removed in 2026

If you are billed more than the Medicare-approved patient responsibility, contact Medicare at 1-800-MEDICARE (1-800-633-4227).

Related reading:

• Is a colonoscopy covered by insurance? Complete guide →
• Colonoscopy billing surprises: the four bills explained →
• What will a colonoscopy cost out-of-pocket? →
• Colonoscopy cost by state →