How much does Medicare pay for CPT 43239?

Medicare allowed an average of $167.49 per service and paid $131.09 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1462.88, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43239?

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope. It was billed 1,596,641 times to 1,544,407 Medicare beneficiaries by 17,191 providers in 2024.

Does 43239 pay differently in an office than a hospital?

Yes. The allowed amount averaged $234.48 in an office setting and $164.83 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 43239 most?

Gastroenterology, with 1,000,185 services from 12,460 clinicians. Next are Ambulatory Surgical Center, Internal Medicine, General Surgery.

CPT 43239

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope

$167.49Medicare-allowed amount per service, averaged across 1,596,641 services

Providers submitted

$1462.88

Asking price, not received

Medicare allowed

$167.49

The fee schedule figure

Medicare paid

$131.09

Balance is patient coinsurance

Providers submitted an average of $1462.88 for this code and Medicare allowed $167.49 — 8.7× 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 $131.09 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $234.48
Hospital / facility: $164.83

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. 61,054 services were billed in an office setting and 1,535,587 in a facility.

Services: 1,596,641
Beneficiaries: 1,544,407
Providers billing it: 17,191
Total allowed: $267,421,401

What Medicare pays for CPT 43239

Across 1,596,641 services billed by 17,191 providers to 1,544,407 beneficiaries, Medicare allowed an average of $167.49 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 43239

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	1,000,185	966,440	$97.41	12,460
Ambulatory Surgical Center	467,744	453,592	$336.60	1,780
Internal Medicine	59,993	57,767	$101.71	869
General Surgery	59,365	57,596	$92.21	1,836
Colorectal Surgery (Proctology)	1,709	1,669	$89.61	52
Hospitalist	1,692	1,624	$97.48	24
Family Practice	1,582	1,542	$101.48	70
Thoracic Surgery	840	793	$100.23	30
Emergency Medicine	807	783	$86.75	9
General Practice	496	453	$112.81	10
Osteopathic Manipulative Medicine	457	448	$86.67	8
Vascular Surgery	256	253	$93.83	7
Anesthesiology	214	204	$277.32	3
Gynecological Oncology	165	157	$89.00	1
Pediatric Medicine	149	145	$89.90	3

43239 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
California	178,619	$203.18	$136.47	1,526
Florida	163,737	$165.93	$134.19	1,276
Texas	117,775	$155.04	$125.56	1,211
New York	100,728	$227.90	$156.17	1,280
New Jersey	69,131	$216.10	$156.88	618
Pennsylvania	67,796	$164.64	$130.51	860
Illinois	60,664	$139.38	$106.51	703
Ohio	54,009	$151.34	$124.20	708
North Carolina	50,202	$162.17	$133.65	558
Georgia	47,327	$165.46	$133.38	493
Maryland	47,288	$188.72	$147.64	381
South Carolina	37,526	$156.44	$130.79	275
Arizona	36,752	$179.23	$142.68	346
Michigan	35,603	$148.41	$117.07	483
Massachusetts	35,255	$150.27	$109.65	474
Virginia	33,799	$143.82	$108.99	400
Tennessee	33,719	$147.14	$125.84	342
Indiana	28,348	$131.58	$105.91	348
Washington	28,024	$164.34	$122.11	381
Missouri	26,244	$128.03	$102.43	354
Louisiana	25,376	$150.89	$129.60	249
Alabama	21,737	$135.66	$119.82	232
Kentucky	21,617	$116.84	$95.89	264
Colorado	21,318	$166.64	$131.11	278
Mississippi	19,947	$144.74	$128.50	133
Wisconsin	18,729	$111.85	$89.62	309
Arkansas	17,280	$159.26	$136.65	146
Connecticut	17,275	$169.30	$123.42	240
Oklahoma	17,107	$125.21	$103.11	170
Kansas	14,769	$137.55	$114.42	164
Minnesota	14,707	$151.21	$117.53	313
Nevada	14,686	$197.31	$152.73	107
Oregon	12,326	$164.48	$122.02	241
Iowa	11,828	$153.69	$130.08	147
Nebraska	9,496	$146.96	$119.35	108
Utah	9,133	$136.96	$109.63	111
Delaware	8,147	$182.09	$141.38	61
Idaho	8,006	$130.08	$106.50	83
New Hampshire	7,637	$129.86	$100.44	89
New Mexico	7,081	$151.58	$122.45	84
Rhode Island	5,899	$171.62	$132.52	62
South Dakota	5,599	$116.30	$95.77	64
West Virginia	5,418	$106.48	$87.04	84
Wyoming	4,782	$150.52	$122.14	39
Alaska	4,343	$229.76	$148.52	53
Hawaii	3,812	$177.37	$129.19	59
Maine	3,653	$115.98	$89.38	69
Montana	3,559	$122.20	$95.25	39
District of Columbia	3,092	$118.38	$83.60	51
North Dakota	2,568	$106.78	$84.87	39
Vermont	1,928	$130.70	$103.02	36
Puerto Rico	750	$290.52	$234.42	36
Guam	222	$169.32	$130.54	7
ZZ	184	$92.01	$73.68	4
U.S. Virgin Islands	84	$142.71	$114.55	3

Related codes

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
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.