How much does Medicare pay for CPT 43247?

Medicare allowed an average of $128.87 per service and paid $100.00 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1059.89, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43247?

Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using a flexible endoscope. It was billed 2,809 times to 2,481 Medicare beneficiaries by 165 providers in 2024.

Which specialty bills 43247 most?

Gastroenterology, with 2,609 services from 154 clinicians. Next are Internal Medicine, Ambulatory Surgical Center, General Surgery.

CPT 43247

Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using a flexible endoscope

$128.87Medicare-allowed amount per service, averaged across 2,809 services

Providers submitted

$1059.89

Asking price, not received

Medicare allowed

$128.87

The fee schedule figure

Medicare paid

$100.00

Balance is patient coinsurance

Providers submitted an average of $1059.89 for this code and Medicare allowed $128.87 — 8.2× 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 $100.00 (78%); the rest is the patient’s coinsurance and deductible.

Services: 2,809
Beneficiaries: 2,481
Providers billing it: 165
Total allowed: $361,996

What Medicare pays for CPT 43247

Across 2,809 services billed by 165 providers to 2,481 beneficiaries, Medicare allowed an average of $128.87 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 43247

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	2,609	2,291	$125.77	154
Internal Medicine	133	125	$99.12	7
Ambulatory Surgical Center	55	53	$344.71	3
General Surgery	12	12	$143.36	1

43247 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	557	$115.89	$77.78	33
Florida	217	$148.66	$110.65	13
Indiana	201	$139.10	$111.76	8
Texas	200	$121.58	$89.23	10
Arizona	150	$113.21	$83.79	7
New York	135	$156.36	$96.83	10
Virginia	126	$135.33	$97.99	8
South Carolina	117	$114.24	$83.06	6
Illinois	115	$143.31	$95.47	8
Michigan	109	$160.96	$123.75	6
Nebraska	81	$112.32	$86.35	4
Colorado	73	$137.98	$103.15	4
Washington	69	$110.98	$73.10	4
Pennsylvania	60	$146.04	$109.69	5
Minnesota	58	$129.02	$94.77	4
Tennessee	55	$114.37	$94.23	4
Maryland	49	$136.88	$99.60	4
Massachusetts	44	$92.14	$61.91	2
Missouri	42	$117.56	$90.36	3
North Carolina	42	$141.63	$100.30	3
New Jersey	41	$119.46	$74.03	2
South Dakota	34	$130.27	$102.14	2
District of Columbia	33	$77.85	$34.48	1
Kentucky	31	$121.34	$90.67	2
Kansas	28	$137.68	$108.73	2
North Dakota	27	$144.26	$115.32	2
New Hampshire	18	$164.34	$129.44	1
Montana	16	$104.06	$64.44	1
Utah	15	$150.71	$114.16	1
Nevada	14	$142.30	$82.59	1
Arkansas	14	$132.75	$110.85	1
Ohio	14	$116.94	$86.73	1
Alabama	13	$151.57	$124.35	1
West Virginia	11	$145.58	$125.53	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.