How much does Medicare pay for CPT 43238?

Medicare allowed an average of $222.24 per service and paid $174.01 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1218.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43238?

Ultrasound guided needle aspiration or biopsy of esophagus using a flexible endoscope. It was billed 13,089 times to 12,598 Medicare beneficiaries by 457 providers in 2024.

Does 43238 pay differently in an office than a hospital?

Yes. The allowed amount averaged $237.66 in an office setting and $222.03 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 43238 most?

Gastroenterology, with 11,992 services from 421 clinicians. Next are Internal Medicine, Ambulatory Surgical Center, Pulmonary Disease.

CPT 43238

Ultrasound guided needle aspiration or biopsy of esophagus using a flexible endoscope

$222.24Medicare-allowed amount per service, averaged across 13,089 services

Providers submitted

$1218.74

Asking price, not received

Medicare allowed

$222.24

The fee schedule figure

Medicare paid

$174.01

Balance is patient coinsurance

Providers submitted an average of $1218.74 for this code and Medicare allowed $222.24 — 5.5× 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 $174.01 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $237.66
Hospital / facility: $222.03

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 174 services were billed in an office setting and 12,915 in a facility.

Services: 13,089
Beneficiaries: 12,598
Providers billing it: 457
Total allowed: $2,908,899

What Medicare pays for CPT 43238

Across 13,089 services billed by 457 providers to 12,598 beneficiaries, Medicare allowed an average of $222.24 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 43238

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	11,992	11,539	$204.46	421
Internal Medicine	533	504	$203.10	19
Ambulatory Surgical Center	429	421	$755.18	12
Pulmonary Disease	71	70	$181.05	1
General Surgery	48	48	$185.20	3
Surgical Oncology	16	16	$187.56	1

43238 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	1,046	$231.20	$157.00	36
Pennsylvania	976	$206.34	$158.76	41
California	941	$215.19	$155.11	28
Texas	746	$255.04	$195.88	29
Illinois	696	$215.55	$155.44	24
Florida	643	$209.51	$157.12	22
Indiana	595	$188.75	$158.03	20
New Jersey	571	$270.87	$190.82	19
Arizona	474	$179.61	$143.17	15
Ohio	468	$233.16	$192.37	16
Missouri	415	$196.72	$154.71	12
Massachusetts	391	$215.83	$157.31	12
Louisiana	387	$361.87	$308.49	8
Wisconsin	367	$249.66	$210.93	15
Minnesota	361	$192.25	$151.46	13
Washington	353	$194.11	$142.77	13
Virginia	342	$203.00	$157.35	14
Tennessee	292	$280.68	$241.11	9
Georgia	281	$207.61	$158.65	11
Michigan	262	$214.14	$157.84	11
Nebraska	251	$202.63	$166.01	4
Maryland	216	$245.89	$184.19	9
Oklahoma	207	$181.83	$148.45	5
Kansas	200	$359.74	$303.02	6
North Carolina	147	$199.88	$168.30	8
Alabama	137	$188.46	$160.20	5
North Dakota	122	$172.85	$138.52	3
Kentucky	117	$176.06	$140.01	5
South Dakota	105	$188.42	$148.98	3
South Carolina	103	$181.14	$149.68	5
Colorado	101	$200.74	$155.85	3
New Hampshire	98	$187.47	$150.27	2
Delaware	87	$198.55	$160.69	3
Arkansas	86	$181.85	$145.44	3
Oregon	82	$198.57	$145.21	4
Vermont	77	$192.91	$149.99	3
Utah	72	$206.02	$161.56	2
Connecticut	54	$227.14	$164.69	4
District of Columbia	49	$248.74	$172.75	3
Maine	40	$216.56	$157.59	2
Mississippi	36	$180.13	$149.24	2
Nevada	25	$186.61	$150.14	1
West Virginia	24	$215.29	$167.10	1
Hawaii	17	$206.04	$141.58	1
Rhode Island	16	$221.06	$161.67	1
Montana	13	$197.70	$156.90	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
43237Ultrasound exam of esophagus$204.08
43246Insertion of stomach tube$194.27

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.