How much does Medicare pay for CPT 43237?

Medicare allowed an average of $204.08 per service and paid $159.02 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1109.54, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43237?

Ultrasound exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope through mouth. It was billed 16,856 times to 16,476 Medicare beneficiaries by 581 providers in 2024.

Does 43237 pay differently in an office than a hospital?

Yes. The allowed amount averaged $189.88 in an office setting and $204.18 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 43237 most?

Gastroenterology, with 15,050 services from 527 clinicians. Next are Ambulatory Surgical Center, Internal Medicine, General Surgery.

CPT 43237

Ultrasound exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope through mouth

$204.08Medicare-allowed amount per service, averaged across 16,856 services

Providers submitted

$1109.54

Asking price, not received

Medicare allowed

$204.08

The fee schedule figure

Medicare paid

$159.02

Balance is patient coinsurance

Providers submitted an average of $1109.54 for this code and Medicare allowed $204.08 — 5.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $159.02 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $189.88
Hospital / facility: $204.18

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 114 services were billed in an office setting and 16,742 in a facility.

Services: 16,856
Beneficiaries: 16,476
Providers billing it: 581
Total allowed: $3,439,972

What Medicare pays for CPT 43237

Across 16,856 services billed by 581 providers to 16,476 beneficiaries, Medicare allowed an average of $204.08 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 43237

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	15,050	14,703	$163.37	527
Ambulatory Surgical Center	1,111	1,094	$778.62	28
Internal Medicine	635	621	$167.91	23
General Surgery	60	58	$159.35	3

43237 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	1,602	$217.02	$144.52	55
California	1,253	$231.49	$154.21	34
Texas	1,111	$245.78	$189.46	43
Pennsylvania	1,071	$165.49	$123.36	42
Florida	1,002	$178.74	$135.38	39
Illinois	772	$169.19	$121.04	31
Arizona	769	$148.29	$116.01	20
Indiana	665	$283.19	$231.19	24
Louisiana	601	$395.47	$344.02	9
Missouri	592	$158.42	$120.51	16
Massachusetts	585	$167.48	$118.33	20
New Jersey	532	$227.54	$156.31	18
Virginia	482	$156.51	$114.54	21
Ohio	471	$161.62	$126.81	22
Washington	434	$163.42	$115.25	19
Michigan	378	$293.56	$232.96	17
Kansas	360	$333.51	$279.79	7
North Carolina	355	$162.98	$131.36	14
Minnesota	345	$157.94	$118.82	11
Maryland	330	$247.07	$187.31	10
Nebraska	292	$177.29	$146.70	6
Arkansas	268	$142.73	$118.56	5
Oklahoma	259	$147.62	$121.26	6
Wisconsin	256	$196.03	$161.81	10
Tennessee	254	$217.32	$184.40	9
Georgia	233	$175.09	$135.95	10
Alabama	231	$237.87	$208.54	8
Nevada	135	$151.24	$114.21	1
Oregon	123	$167.59	$120.08	6
Colorado	121	$167.98	$125.61	6
Delaware	116	$143.95	$108.53	3
South Carolina	104	$156.09	$120.15	5
South Dakota	104	$140.01	$132.81	2
Kentucky	99	$154.17	$121.26	3
New Hampshire	96	$152.88	$120.22	4
Utah	84	$171.73	$133.21	5
Connecticut	74	$177.34	$121.87	5
North Dakota	71	$132.11	$102.10	3
Vermont	51	$157.47	$126.05	3
West Virginia	50	$162.81	$121.62	2
District of Columbia	45	$208.33	$130.60	2
Mississippi	33	$149.24	$125.14	2
Maine	17	$136.79	$115.64	1
Montana	16	$157.32	$123.78	1
Alaska	14	$115.13	$82.46	1

Related codes

43239Biopsy of esophagus$167.49
43235Diagnostic exam of esophagus$145.31
43249Balloon dilation of esophagus$337.40
43248Insertion of guide wire$223.15
43264Removal of stone or debris from bile or pancreatic duct$135.60
43251Removal of polyps or growths of esophagus$419.64
43274Insertion of stent into pancreatic or bile duct$392.61
43259Ultrasound exam of esophagus$230.50
43242Ultrasound guided needle aspiration or biopsy of esophagus$249.98
43255Control of bleeding of esophagus$200.78
43246Insertion of stomach tube$194.27
43238Ultrasound guided needle aspiration or biopsy of esophagus$222.24

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.