How much does Medicare pay for CPT 43246?

Medicare allowed an average of $194.27 per service and paid $154.08 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $927.28, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43246?

Insertion of stomach tube using a flexible endoscope. It was billed 15,365 times to 14,542 Medicare beneficiaries by 692 providers in 2024.

Which specialty bills 43246 most?

Gastroenterology, with 11,601 services from 499 clinicians. Next are General Surgery, Internal Medicine, Thoracic Surgery.

CPT 43246

Insertion of stomach tube using a flexible endoscope

$194.27Medicare-allowed amount per service, averaged across 15,365 services

Providers submitted

$927.28

Asking price, not received

Medicare allowed

$194.27

The fee schedule figure

Medicare paid

$154.08

Balance is patient coinsurance

Providers submitted an average of $927.28 for this code and Medicare allowed $194.27 — 4.8× 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 $154.08 (79%); the rest is the patient’s coinsurance and deductible.

Services: 15,365
Beneficiaries: 14,542
Providers billing it: 692
Total allowed: $2,984,959

What Medicare pays for CPT 43246

Across 15,365 services billed by 692 providers to 14,542 beneficiaries, Medicare allowed an average of $194.27 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 43246

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	11,601	10,942	$197.70	499
General Surgery	2,095	2,031	$169.95	123
Internal Medicine	1,062	994	$203.62	36
Thoracic Surgery	117	115	$167.28	8
Pulmonary Disease	107	104	$174.57	3
Hospitalist	101	95	$193.07	4
Critical Care (Intensivists)	50	50	$165.89	4
Surgical Oncology	41	41	$140.86	3
Vascular Surgery	36	33	$186.97	2
General Practice	35	35	$159.88	3
Otolaryngology	33	32	$133.45	2
Ambulatory Surgical Center	31	20	$686.06	1
Colorectal Surgery (Proctology)	31	26	$170.49	2
Nurse Practitioner	13	12	$161.21	1
Physician Assistant	12	12	$161.99	1

43246 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	3,829	$199.15	$150.66	118
Florida	1,619	$204.55	$151.54	73
Texas	1,536	$185.84	$147.02	72
New York	1,509	$209.89	$139.74	65
New Jersey	833	$189.52	$134.32	44
Illinois	610	$203.58	$147.06	30
Louisiana	475	$217.20	$182.41	26
Ohio	433	$180.11	$142.10	24
Mississippi	394	$178.21	$145.70	20
Maryland	382	$204.20	$149.51	20
Michigan	327	$196.57	$149.69	14
Arkansas	301	$172.91	$148.71	12
Alabama	296	$173.68	$150.14	17
Indiana	278	$173.30	$150.41	17
Pennsylvania	245	$187.58	$142.56	17
Oklahoma	234	$179.47	$148.26	13
Tennessee	221	$180.92	$150.78	12
Missouri	200	$175.78	$136.98	12
Nevada	178	$200.51	$151.90	7
Georgia	165	$176.44	$143.19	10
Virginia	158	$189.30	$146.81	8
Massachusetts	156	$189.10	$135.04	9
North Carolina	116	$155.10	$129.37	5
West Virginia	114	$168.51	$138.45	5
Kentucky	104	$166.86	$132.00	7
Iowa	96	$179.01	$147.92	5
District of Columbia	91	$216.78	$146.94	2
South Carolina	75	$156.48	$127.06	3
Kansas	67	$174.88	$145.98	5
Minnesota	56	$171.65	$126.54	4
Arizona	51	$200.83	$147.20	3
Rhode Island	50	$193.30	$153.79	2
Utah	48	$187.06	$137.99	2
Wisconsin	30	$179.13	$143.97	2
Colorado	26	$191.57	$145.10	2
Oregon	25	$161.58	$130.64	2
Montana	13	$179.52	$130.34	1
Connecticut	12	$195.29	$154.29	1
Delaware	12	$161.68	$121.89	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
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.