Cologuard is an at-home colorectal cancer screening test made by Exact Sciences. You collect a stool sample at home, ship it in a prepaid box directly to the Exact Sciences laboratory in Madison, Wisconsin, and receive results from your ordering provider within a few weeks. The test screens for DNA markers and blood in stool associated with colorectal cancer and precancerous polyps.
The pricing model is unusual compared to most medical procedures. Cologuard has a single nationwide list price set by Exact Sciences, not a variable chargemaster price set by a hospital or clinic. The self-pay price in 2026 is $649 for the standard Cologuard test and $599 for Cologuard Plus, their newer version. If you have Medicare or most major commercial insurance, the test is covered as a preventive screening with no cost-sharing for eligible patients. A positive Cologuard result typically triggers a follow-up colonoscopy, which is a separate and significantly more expensive procedure.
This guide covers the 2026 self-pay price, what Medicare pays under the Clinical Laboratory Fee Schedule, how to avoid billing errors on the colonoscopy that may follow a positive result, and what factors change your out-of-pocket cost. Medicare covers Cologuard once every three years for patients 45 to 85 with average colorectal cancer risk — see whether Medicare covers colonoscopy for the detailed coverage rules.
Cologuard Cost by Site of Service in 2026
The biggest cost driver of Cologuard is the site of service: where the procedure is performed. 2026 CMS price transparency data confirms a 2-3x billing differential between independent centers and hospital outpatient departments.
Cologuard prices without insurance vs. 2026 Medicare rates| Site of Service | Range Without Insurance | 2026 Medicare Rate |
|---|
| Self-pay (standard Cologuard) | $649 | Not applicable |
| Self-pay (Cologuard Plus) | $599 | Not applicable |
| Medicare Part B (preventive screening, eligible beneficiaries) | $0 cost-sharing | ~$509 (CLFS rate for CPT 81528) |
| Commercial insurance (in-network, preventive) | $0 to $75 typical copay | Not applicable |
Self-pay prices are published list prices from Exact Sciences (2026). Medicare CLFS rate for CPT 81528 based on 2025-2026 Clinical Laboratory Fee Schedule data. Eligible Medicare beneficiaries owe $0 cost-sharing for covered preventive screening.
Source: Exact Sciences published self-pay pricing 2026, CMS Clinical Laboratory Fee Schedule 2026, CMS NCD 210.3
Why the Same Procedure Is So Much More at a Hospital
Unlike most diagnostic imaging or surgical procedures, Cologuard does not vary meaningfully by site of service. The test kit is always shipped to your home and then mailed to the Exact Sciences central laboratory for processing. The list price is fixed nationwide at $649 for the standard test. Exact Sciences does offer a patient assistance program for uninsured patients who qualify based on income, which can reduce or eliminate the cost.
Medicare pays for Cologuard through the Clinical Laboratory Fee Schedule (CLFS), not the Physician Fee Schedule or OPPS. The 2026 CLFS rate for CPT 81528 is approximately $509, but eligible Medicare beneficiaries owe $0 in deductible or coinsurance because the test qualifies as a covered preventive screening under Section 1861(pp)(1) of the Social Security Act. The Part B deductible and 20% coinsurance are waived entirely for qualifying patients.
If your Cologuard result comes back positive, your doctor will likely order a colonoscopy. That follow-up colonoscopy is still considered part of the colorectal cancer screening sequence under current Medicare rules (effective January 2023), so it can also be covered with reduced or no cost-sharing, provided the correct billing codes and modifiers are used.
Cologuard vs. Cologuard Plus: Price and Performance Comparison
Exact Sciences markets two versions of the stool DNA test in 2026. The original Cologuard (launched 2014) and the newer Cologuard Plus (launched 2024), which uses an updated algorithm with higher sensitivity for colorectal cancer. The billing codes and Medicare coverage status differ.
Typical cost by variant| Version | Self-Pay Price | Medicare Coverage | Sensitivity for CRC |
|---|
| Cologuard (original) | $649 | Covered, $0 cost-sharing | 92% |
| Cologuard Plus | $599 (self-pay) | Coverage varies by plan; confirm before ordering | 94% |
Sensitivity figures are from the BLUE-C clinical trial published in the New England Journal of Medicine (2023). Medicare Advantage plans may or may not cover Cologuard Plus as of 2026 - verify with your specific plan.
Source: Exact Sciences, New England Journal of Medicine (BLUE-C trial 2023), CMS NCD 210.3
What Medicare Pays for Cologuard
Medicare Part B covers the standard Cologuard test (CPT 81528) once every 36 months for beneficiaries who are ages 45 to 85, have no symptoms of colorectal disease, and are at average risk for colorectal cancer. Coverage applies with $0 deductible and $0 coinsurance, which means the 2026 Part B deductible of $283 and the standard 20% coinsurance do not apply. The Medicare Clinical Laboratory Fee Schedule rate is approximately $509 for this test in 2026.
Medicare Advantage plans are required to cover Cologuard at no cost-sharing every three years for eligible members. However, Cologuard Plus coverage under Medicare Advantage varies by plan as of 2026, so verify before ordering. If your Cologuard is positive and your doctor orders a follow-up colonoscopy, that colonoscopy qualifies as part of the colorectal cancer screening sequence under rules effective since January 1, 2023. When the provider uses the correct billing modifier (KX on the colonoscopy claim), Medicare covers it with reduced or no cost-sharing. Without the KX modifier, the colonoscopy is adjudicated as diagnostic and standard cost-sharing applies.
What Factors Affect Cost
- Insurance status: Medicare and most commercial plans cover Cologuard as a preventive screening at $0 cost-sharing for eligible patients.
- Age and risk level: Coverage requires average risk and no symptoms. High-risk patients (family history, prior polyps) are typically referred to colonoscopy instead, which has different pricing.
- Which version: Cologuard Plus ($599 self-pay) vs. standard Cologuard ($649 self-pay). Insurance coverage for Cologuard Plus varies more than for the original.
- Follow-up colonoscopy if result is positive: A positive Cologuard triggers a colonoscopy. That procedure has its own pricing ($1,000 to $4,500 without insurance depending on site of service).
- Patient assistance: Exact Sciences offers a financial assistance program for uninsured or underinsured patients who cannot afford the list price. Eligibility is income-based.
- Frequency: Cologuard is approved every three years. Using it more frequently than the approved interval may result in the test being denied as non-covered.
Common Cologuard Billing Errors
Cologuard itself is billed directly by Exact Sciences, so billing errors on the test are rare. The billing errors that cost patients money happen on the follow-up colonoscopy after a positive result:
- Missing KX modifier on the colonoscopy claim: Medicare requires modifier KX to identify a colonoscopy performed after a positive stool-based test. Without it, Medicare adjudicates the colonoscopy as diagnostic, and the patient owes the full Part B deductible plus 20% coinsurance.
- Cologuard ordered for a high-risk patient: The test is approved for average-risk patients only. Ordering it for someone with a family history of colorectal cancer or prior polyps may result in a coverage denial.
- Cologuard ordered too soon: Medicare covers the test once every 36 months. Ordering it at 30 or 33 months will likely result in a denial. Patients may then owe the full $649 list price.
- Wrong modifier on colonoscopy when polyp is removed: If a polyp is removed during the follow-up colonoscopy, modifier PT must be added to each therapeutic CPT code. From 2023 to 2026, patients owe 15% of the colonoscopy cost when a polyp is removed during a screening sequence. Without PT, standard diagnostic cost-sharing applies.
- Billing the test as diagnostic instead of screening: If symptoms are documented in the chart at the time of the Cologuard order, Medicare will deny the preventive screening benefit and bill it as a diagnostic lab test with standard cost-sharing.
Frequently Asked Questions
How much does Cologuard cost without insurance in 2026?
Without insurance, the standard Cologuard test costs $649 and Cologuard Plus costs $599 as of 2026. Both prices are set directly by Exact Sciences and are the same nationwide. The test is mailed to your home and returned to the Exact Sciences laboratory for processing. Exact Sciences offers a patient assistance program for those who qualify based on income.
Does Medicare cover Cologuard in 2026?
Yes. Medicare Part B covers the standard Cologuard test (CPT 81528) once every three years for beneficiaries ages 45 to 85 who are at average risk for colorectal cancer and have no symptoms. The deductible and coinsurance are waived entirely, so eligible beneficiaries pay $0. The Medicare Clinical Laboratory Fee Schedule rate is approximately $509.
What happens to my Medicare coverage if my Cologuard is positive?
A follow-up colonoscopy after a positive Cologuard is covered as part of the colorectal cancer screening sequence under Medicare rules effective since January 1, 2023. Your provider must add modifier KX to the colonoscopy claim. With the correct modifier, cost-sharing is reduced or waived. Without it, Medicare treats the colonoscopy as diagnostic and standard Part B cost-sharing applies, including the $283 deductible and 20% coinsurance.
Is Cologuard covered by commercial insurance?
Most major commercial insurers cover Cologuard as a preventive colorectal cancer screening with no cost-sharing for average-risk adults ages 45 and older, under the ACA's preventive services mandate. Coverage for Cologuard Plus varies more widely, so confirm with your plan before ordering. If coverage is denied, you can appeal or pay the self-pay list price of $649 (standard) or $599 (Plus).
What is the difference between Cologuard and Cologuard Plus?
Cologuard Plus is a newer version launched in 2024 that uses an updated detection algorithm with approximately 94% sensitivity for colorectal cancer, compared to 92% for the original. The self-pay price for Cologuard Plus is $599, slightly less than the $649 original. Medicare covers the original Cologuard; coverage for Cologuard Plus under Medicare and Medicare Advantage varies as of 2026.
How does Cologuard pricing compare to a colonoscopy?
Cologuard costs $649 self-pay without insurance in 2026. A colonoscopy costs $1,000 to $4,500 without insurance depending on site of service, with independent ambulatory surgery centers running $1,000 to $2,000 and hospital outpatient departments running $2,000 to $4,500. However, if your Cologuard is positive, you will also need a colonoscopy, making the combined cost higher than a colonoscopy alone.
Can I use my HSA or FSA to pay for Cologuard?
Yes. Cologuard is an eligible expense under Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). The $649 standard price or $599 Cologuard Plus price can be paid using tax-advantaged HSA or FSA funds, which effectively reduces the after-tax cost by your marginal tax rate.
What billing errors should I watch for after a positive Cologuard result?
The main billing risk after a positive Cologuard is a colonoscopy billed without the KX modifier. Medicare requires KX on the colonoscopy claim to identify it as a follow-up to a positive stool-based screening test. Without it, your colonoscopy may be billed as a diagnostic procedure and you could owe the full Part B deductible ($283 in 2026) plus 20% coinsurance. Ask your provider to confirm they will use the KX modifier before the colonoscopy.
