What Medicare Pays vs. What You Might Be Charged

Category	Amount
Medicare Allowed Rate What Medicare approves for this service	$99.82
Typical Billed Amount What providers commonly charge	$150 – $600
Potential Markup How much more you might pay vs. Medicare rate	501% above Medicare

Why the difference? Providers set their own prices. Without insurance, you may be billed the full amount. Even with insurance, your co-pay is often based on the provider's charge — not the Medicare rate.

What CPT Code 58100 Means

CPT code 58100 covers endometrial sampling, commonly known as an endometrial biopsy. During this procedure, your doctor takes a small tissue sample from the endometrium (the lining of your uterus) to examine under a microscope.

Your doctor might recommend this procedure if you're experiencing abnormal uterine bleeding, irregular periods, or if they need to rule out conditions like endometrial cancer or other uterine disorders. The procedure can be done with or without cervical dilation, depending on your specific situation.

This is typically an in-office procedure that takes just a few minutes, though you may experience some cramping similar to menstrual cramps during and after the biopsy.

Billing and Costs for CPT 58100

When you receive your medical bill, you'll see CPT code 58100 listed for your endometrial biopsy. The Medicare reimbursement rate for this procedure is $99.82, but what you're charged will likely be higher.

Typical charges for this procedure range from $150 to $600, depending on your healthcare provider and geographic location. The final amount you pay will depend on your insurance coverage, deductible, and whether you've met your out-of-pocket maximum for the year.

Your bill should clearly show the procedure code 58100 along with a description like "endometrial sampling" or "endometrial biopsy." If you see additional codes on the same date of service, these might be for the office visit or other related services performed during your appointment.

How to Verify Your Bill is Correct

To check if your CPT 58100 charge is accurate, first confirm that you actually received an endometrial biopsy on the date listed. The charge should fall within the typical range of $150 to $600 - if it's significantly higher, it's worth questioning.

Make sure you're not seeing duplicate charges for the same procedure or confused billing codes. CPT 58100 is sometimes mixed up with similar codes like 58110 (endometrial curettage) or 58120 (dilation and curettage), which are different procedures with different costs.

If you notice any discrepancies or have questions about your bill, contact your healthcare provider's billing department first. They can explain the charges and correct any errors. If you're still unsure, you can also contact your insurance company to review the claim and ensure proper coverage was applied.

Codes Often Confused With CPT 58100

CPT 58110 CPT 58120

Frequently Asked Questions

How much does an endometrial biopsy cost?

The cost for an endometrial biopsy (CPT 58100) typically ranges from $150 to $600 before insurance. Your actual out-of-pocket cost will depend on your insurance coverage, deductible, and copay requirements.

Will insurance cover CPT code 58100?

Most insurance plans, including Medicare, cover endometrial biopsies when medically necessary. Medicare reimburses providers $99.82 for this procedure, and private insurance coverage varies by plan and whether you've met your deductible.

What should I do if my endometrial biopsy bill seems too high?

If your CPT 58100 charge is significantly above $600 or you see unexpected additional charges, contact your provider's billing department to review the bill. Make sure you weren't charged for procedures you didn't receive and that insurance was properly applied.