How much does Medicare pay for CPT 43248?

Medicare allowed an average of $223.15 per service and paid $174.09 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1371.41, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43248?

Insertion of guide wire with dilation of esophagus using a flexible endoscope. It was billed 104,265 times to 97,947 Medicare beneficiaries by 2,419 providers in 2024.

Does 43248 pay differently in an office than a hospital?

Yes. The allowed amount averaged $220.54 in an office setting and $223.19 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 43248 most?

Gastroenterology, with 62,423 services from 1,723 clinicians. Next are Ambulatory Surgical Center, Internal Medicine, General Surgery.

CPT 43248

Insertion of guide wire with dilation of esophagus using a flexible endoscope

$223.15Medicare-allowed amount per service, averaged across 104,265 services

Providers submitted

$1371.41

Asking price, not received

Medicare allowed

$223.15

The fee schedule figure

Medicare paid

$174.09

Balance is patient coinsurance

Providers submitted an average of $1371.41 for this code and Medicare allowed $223.15 — 6.1× 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 $174.09 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $220.54
Hospital / facility: $223.19

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,764 services were billed in an office setting and 102,501 in a facility.

Services: 104,265
Beneficiaries: 97,947
Providers billing it: 2,419
Total allowed: $23,266,735

What Medicare pays for CPT 43248

Across 104,265 services billed by 2,419 providers to 97,947 beneficiaries, Medicare allowed an average of $223.15 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 43248

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	62,423	58,376	$136.27	1,723
Ambulatory Surgical Center	37,107	35,288	$380.63	539
Internal Medicine	3,012	2,772	$132.46	92
General Surgery	714	670	$134.55	32
Thoracic Surgery	697	557	$146.62	25
Emergency Medicine	101	98	$115.35	2
General Practice	84	65	$124.95	1
Hospitalist	39	39	$134.88	1
Cardiac Surgery	33	29	$147.58	1
Otolaryngology	22	20	$124.07	1
Gynecological Oncology	19	19	$133.10	1
Colorectal Surgery (Proctology)	14	14	$109.42	1

43248 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
Florida	11,777	$234.23	$188.47	215
Texas	9,974	$211.93	$172.49	228
Tennessee	6,100	$208.33	$178.35	122
Georgia	5,442	$245.40	$198.74	122
North Carolina	4,767	$244.94	$201.63	92
Mississippi	4,606	$206.72	$181.95	60
Pennsylvania	4,419	$221.52	$179.58	115
California	4,318	$270.84	$184.99	116
Washington	3,710	$244.31	$182.49	99
Colorado	3,352	$249.74	$197.37	82
Ohio	3,180	$224.29	$184.46	87
South Carolina	3,152	$222.16	$186.00	65
Indiana	2,782	$225.76	$182.75	71
Illinois	2,771	$175.09	$139.79	63
Idaho	2,741	$217.56	$180.03	47
Louisiana	2,548	$215.95	$185.51	64
Missouri	2,527	$197.81	$162.58	61
Arizona	2,415	$223.12	$176.74	53
Virginia	2,003	$202.08	$154.88	59
Michigan	1,905	$222.35	$178.85	51
Oklahoma	1,864	$177.33	$144.83	39
Alabama	1,780	$209.19	$186.05	44
Kentucky	1,697	$164.97	$142.34	38
Wisconsin	1,605	$181.66	$147.56	54
Maryland	1,569	$263.46	$205.15	41
Nevada	1,084	$257.83	$205.89	21
Oregon	982	$245.49	$182.98	38
Wyoming	959	$222.47	$181.88	11
Arkansas	884	$225.32	$197.00	22
Minnesota	841	$239.78	$186.37	28
New York	828	$175.88	$133.77	34
Kansas	761	$211.92	$176.89	22
Iowa	592	$175.85	$148.26	12
Rhode Island	540	$259.47	$202.15	19
Massachusetts	529	$178.65	$129.26	23
New Jersey	514	$280.46	$207.27	24
Nebraska	462	$248.26	$200.99	12
South Dakota	447	$208.81	$175.71	6
New Mexico	403	$250.41	$204.71	9
West Virginia	230	$198.20	$174.65	5
Utah	227	$201.13	$159.13	8
Alaska	212	$299.09	$201.48	6
Delaware	148	$258.89	$189.91	4
North Dakota	143	$231.05	$184.26	5
New Hampshire	115	$136.45	$104.73	6
Maine	108	$277.79	$214.66	5
Montana	106	$197.36	$158.52	5
Connecticut	67	$137.37	$102.48	3
District of Columbia	52	$171.67	$123.02	2
Hawaii	27	$144.10	$106.99	1

Related codes

43239Biopsy of esophagus$167.49
43235Diagnostic exam of esophagus$145.31
43249Balloon dilation of esophagus$337.40
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.