Ca screen;flexi sigmoidscope
Cancer screening using flexible sigmoidoscopy costs range from $53.71 at Medicare rates to $911.71 at hospital outpatient facilities, making it essential to verify your billing location before your procedure.
About the analyst
Elena Vasquez leads hospital billing pattern analysis at BillRazor Research. She focuses on identifying overcharges, markup outliers, and patient advocacy strategies. Expertise: hospital billing patterns, overcharge analysis, patient advocacy.
G0104 covers flexible sigmoidoscopy, a screening procedure where a thin, flexible tube with a camera examines the lower portion of the colon to detect cancer or precancerous polyps. This preventive service is typically performed on average-risk adults aged 50-75 as part of routine colorectal cancer screening. Medicare reimburses this procedure as a covered preventive benefit when performed within appropriate intervals, making proper documentation of screening versus diagnostic intent essential for accurate billing.
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Common billing errors
When reviewing Procedures & Services bills for temporary procedures, watch for several common billing patterns. Duplicate charges frequently occur when the same temporary procedure code appears multiple times within a single date of service, particularly with monitoring or observational codes that should be billed once per session. Unbundling errors are common when temporary diagnostic procedures are separated into component parts rather than using the appropriate comprehensive code, creating charges above the benchmark rates. Code confusion often happens between similar temporary procedure codes with significantly different Medicare rates - some procedures are valued at $0 while others reach $1,363, making accurate code selection critical. Additionally, verify that temporary procedures aren't billed alongside permanent procedure codes for the same service area on the same date, as this creates inappropriate dual billing. Given the wide rate variation in this 227-code category, confirm that the specific temporary procedure code matches the actual service provided and duration documented in your medical records.
Facility rate
$54
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
4
24 data points
Key insights for HCPCS G0104
ASC vs hospital outpatient savings
$763Having this done at an ambulatory surgery center costs $149 vs $912 at a hospital outpatient
Facility vs office setting
$45 differenceFacility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $54 | Lowest |
| Non-facility (office) | $99 | +84% |
| Outpatient (APC) | $912 | +1597% |
| Ambulatory surgery (ASC) | $149 | +177% |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Related procedures
FAQ — Temporary Procedures & Services billing
What is the Medicare reimbursement range for Temporary Procedures & Services?
How should I verify appropriate billing rates for temporary procedures?
Why do some temporary procedures have a $0 Medicare rate?
What billing considerations apply to the temporary procedure category?
Related pricing data
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use