HCPCS G0121 cost and Medicare rate
For code G0121, colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk, Medicare's 2026 national rate for the hospital's facility fee is about $950, and its rate for the doctor's part nationally is about $165, so about $1,115 in all. In 2024, doctors nationally typically billed about $1,628 for their part. The hospital and the doctor usually send separate bills. Medicare rates are a common benchmark, not what every plan pays.
What HCPCS G0121 is
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk.
What Medicare pays for G0121 nationally
| Setting | Medicare 2026 | Medicare allowed 2024 | Typically billed 2024 |
|---|---|---|---|
| Hospital or surgery center (doctor's part) | $165.00 | $276.80 | $1,627.58 |
Medicare 2026 is the national fee schedule rate (conversion factor 33.4009). "Medicare allowed" and "typically billed" are averages from Medicare claims in 2024.
If it was done in a hospital
Medicare's national hospital outpatient (OPPS) rate for the hospital's own facility fee, before each hospital's local wage adjustment, which raises it in high-cost areas and lowers it in low-cost ones. The doctor bills separately under the fee schedule.
Medicare's July 2026 national rate for the hospital's facility fee for G0121 is $950.10 (payment group APC 5311).
G0121 by state
Where you were treated changes the benchmark. Medicare's 2026 rate depends on the pricing area. The table shows the rest-of-state rate and the range across each state's pricing areas; some big cities have their own, higher rate. Billed amounts are what providers typically billed in a hospital or other facility in 2024.
| State and Medicare pricing area | Doctor's part 2026 | Range in state (doctor's part) | Typically billed 2024 |
|---|---|---|---|
| California Rest of California | $164.59 | $398.51 to $497.73 29 pricing areas | $2,194.63 |
| New York Rest of New York | $158.60 | $361.36 to $446.05 5 pricing areas | $1,992.03 |
| Texas Rest of Texas | $161.36 | $354.20 to $392.02 8 pricing areas | $2,086.22 |
| Florida Rest of Florida | $170.09 | $374.13 to $410.47 3 pricing areas | $1,733.89 |
| Illinois Rest of Illinois | $169.00 | $363.87 to $398.63 4 pricing areas | $1,594.99 |
| Ohio Statewide | $161.22 | One rate statewide | $1,186.12 |
| Georgia Rest of Georgia | $162.86 | $353.24 to $385.70 2 pricing areas | $1,256.34 |
| Washington Rest of Washington | $165.40 | $390.14 to $439.78 2 pricing areas | $1,050.77 |
| Pennsylvania Rest of Pennsylvania | $160.56 | $356.49 to $393.64 2 pricing areas | $1,212.05 |
| Arizona Statewide | $161.59 | One rate statewide | $1,781.27 |
What your charge for G0121 means
Med Bill Check compares a charge with Medicare's rate and with what providers typically billed. Here is how it reads three national charges, each compared with the hospital facility fee plus doctor's fee:
- Charged $1,100: Your $1,100 is close to what Medicare would pay the hospital and the doctor together, which is a good sign. If it is only the hospital's charge, it is about 1.2 times the hospital's rate. Medicare rates are a common benchmark, not what every plan pays.
- Charged $2,250: Your $2,250 is about 2 times what Medicare would pay the hospital and the doctor together. If it is only the hospital's charge, it is about 2.4 times the hospital's rate. That is a common benchmark rather than a verdict, and an itemized bill will show which charges are the hospital's and which are the doctor's.
- Charged $4,450: Your $4,450 is about 4 times what Medicare would pay the hospital and the doctor together. If it is only the hospital's charge, it is about 4.7 times the hospital's rate. That is a common benchmark rather than a verdict, and an itemized bill will show which charges are the hospital's and which are the doctor's.
Medicare rates are a common benchmark, not what every plan or provider charges, and never proof a bill is wrong. Enter your own charge and state on the home page for your figures.
Common billing questions for G0121
- Units: Medicare's automated limit for G0121 is 1 unit for one patient on one day (NCCI Medically Unlikely Edits). If your bill shows more, ask them to confirm the units. Medicare limits (MUE) are the most units Medicare pays automatically for one patient on one day. Going over is a reason to ask, not proof of an error, since some cases are allowed with records.
- Duplicates and services you did not get: Look for duplicate lines, services you did not receive, and unit counts that look high.
- Two bills: The hospital and the doctor usually send separate bills. Check which one each charge is on before comparing it with a rate.
How to question a charge for G0121
- Ask for an itemized bill with codes, units and prices. Itemized bill letter.
- Compare each line with your Explanation of Benefits if you have insurance.
- Ask the billing office to review the charge in writing, and to hold the account from collections meanwhile. Charge review letter.
- Ask for a prompt-pay or self-pay discount, or an interest-free payment plan. Discount letter.
- If it was a hospital, ask for its financial assistance policy. Financial assistance letter and which hospitals must offer it.
With your code and amount, the review letter adds the benchmark for you, for example: For reference, Medicare's 2026 fee schedule rate for code G0121 nationally is about $378, and Medicare's published data shows providers nationally typically billed about $1,628 in 2024.
Keep a copy of everything you send, and note the date and the name of anyone you speak to. If you have insurance, call your insurer too. They can check whether the claim was processed correctly.
Quick answers
- What is HCPCS G0121?
- Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk.
- How much does Medicare pay for G0121 in 2026?
- Nationally, Medicare's 2026 rate is $950.10 for the hospital's facility fee and $165.00 for the doctor's part. The hospital and the doctor usually send separate bills.
- What do providers typically charge for G0121?
- In 2024, providers nationally typically billed $1,627.58 for G0121 in a hospital or other facility.
- Is $4,450 for G0121 too much?
- Your $4,450 is about 4 times what Medicare would pay the hospital and the doctor together. If it is only the hospital's charge, it is about 4.7 times the hospital's rate. That is a common benchmark rather than a verdict, and an itemized bill will show which charges are the hospital's and which are the doctor's.
- How much is G0121 in Texas?
- For code G0121, colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk, Medicare's 2026 national rate for the hospital's facility fee is about $950, and its rate for the doctor's part in Texas is about $161, so about $1,111 in all. In 2024, doctors in Texas typically billed about $2,086 for their part. The hospital and the doctor usually send separate bills. Medicare rates are a common benchmark, not what every plan pays.
- How many units of G0121 can be billed in one day?
- Medicare's automated limit is 1 for one patient on one day. Going over is a reason to ask, not proof of an error, since some cases are allowed with records.
Sources
- CMS Medicare Physician Fee Schedule, 2026 (pfs.data.cms.gov)
- CMS Hospital Outpatient Prospective Payment System (OPPS) Addendum B, July 2026 (cms.gov), national unadjusted payment rates
- CMS Medicare Physician and Other Practitioners by Geography and Service, 2024 data (data.cms.gov)
- CMS NCCI Medically Unlikely Edits, effective 2026-10-01
General information, not medical, legal or financial advice. Medicare rates are a common benchmark, not what every plan or provider charges. For your own bill, check with the billing office, your insurer or your doctor.
Ask Med Bill Check yourself
Enter the code or the service in plain words, your state and what you were charged, and see how it compares with Medicare's rate. Open Med Bill Check, free, no sign-up.
In Claude or any app that takes MCP connectors, add https://goodturn-mcp.pages.dev/medbillcheck/mcp and ask: “Is $2,250 for G0121 in Texas too much?”
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