How much does Medicare pay for CPT 43270?

Medicare allowed an average of $264.28 per service and paid $203.07 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1986.82, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43270?

Destruction of polyp or growth of esophagus, stomach, and/or upper small bowel using a flexible endoscope. It was billed 4,759 times to 3,559 Medicare beneficiaries by 180 providers in 2024.

Does 43270 pay differently in an office than a hospital?

Yes. The allowed amount averaged $166.14 in an office setting and $265.66 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 43270 most?

Gastroenterology, with 4,208 services from 157 clinicians. Next are Ambulatory Surgical Center, Internal Medicine, General Surgery.

CPT 43270

Destruction of polyp or growth of esophagus, stomach, and/or upper small bowel using a flexible endoscope

$264.28Medicare-allowed amount per service, averaged across 4,759 services

Providers submitted

$1986.82

Asking price, not received

Medicare allowed

$264.28

The fee schedule figure

Medicare paid

$203.07

Balance is patient coinsurance

Providers submitted an average of $1986.82 for this code and Medicare allowed $264.28 — 7.5× 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 $203.07 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $166.14
Hospital / facility: $265.66

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 66 services were billed in an office setting and 4,693 in a facility.

Services: 4,759
Beneficiaries: 3,559
Providers billing it: 180
Total allowed: $1,257,709

What Medicare pays for CPT 43270

Across 4,759 services billed by 180 providers to 3,559 beneficiaries, Medicare allowed an average of $264.28 per service. That is 1.3 services per beneficiary, so this is a code patients typically receive more than once. 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 43270

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	4,208	3,118	$203.70	157
Ambulatory Surgical Center	344	284	$1033.85	14
Internal Medicine	128	81	$234.27	4
General Surgery	79	76	$189.11	5

43270 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	669	$231.29	$175.24	17
Massachusetts	442	$221.05	$150.12	14
California	368	$341.44	$231.27	17
Texas	327	$189.23	$128.18	9
Indiana	294	$462.29	$374.68	10
South Carolina	238	$188.02	$141.14	9
Ohio	184	$279.29	$221.71	9
Minnesota	184	$328.19	$243.91	6
Maryland	182	$213.89	$148.63	6
Missouri	178	$369.49	$318.60	5
Pennsylvania	152	$273.61	$213.52	8
Illinois	151	$224.52	$156.15	6
New York	147	$236.30	$154.28	7
Tennessee	111	$306.18	$257.11	6
Mississippi	109	$337.89	$280.38	4
New Jersey	103	$364.98	$266.97	4
North Carolina	98	$195.12	$156.72	4
Arizona	90	$202.47	$154.79	4
Virginia	83	$196.14	$148.13	3
Alabama	82	$368.29	$328.87	4
Colorado	65	$216.30	$164.77	2
Michigan	64	$201.53	$156.57	3
Louisiana	64	$209.71	$159.53	4
North Dakota	52	$207.18	$163.43	2
District of Columbia	52	$248.16	$151.08	2
Arkansas	48	$196.88	$161.58	2
New Hampshire	47	$209.28	$156.30	2
Kentucky	39	$190.00	$150.42	2
Oklahoma	34	$197.58	$166.29	2
Georgia	24	$209.12	$150.76	2
New Mexico	20	$219.22	$156.16	1
Wisconsin	17	$196.65	$166.94	1
Connecticut	17	$190.16	$142.04	1
Kansas	12	$158.83	$132.25	1
Washington	12	$233.97	$161.32	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.