CPT 43239 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Esophagogastroduodenoscopy Procedures Endoscopy Procedures on the Esophagus |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43239 |
National average reimbursement for CPT 43239 by major payers:

$431.86

$480.56

$538.52

$259.90
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 43239 | $652.86 | 1619041977 - RAPHAEL PAISNER | 274980253 - PRIMARY CARE PARTNERS, LLC | NJ | Pediatrics Physician (208000000X) |
United | 43239 | $382.67 | 1386605657 - ANUPAMA NUTAKKI | 272337725 - (AZ) GREATER PHOENIX COLLABORATIVE CARE PC | AZ | Internal Medicine Physician (207R00000X) |
United | 43239 | $650.77 | 1477534196 - ROBIN JACOBSON | 135562308 - NEW YORK UNIVERSITY | NY | Pediatrics Physician (208000000X) |
United | 43239 | $749.65 | 1528034352 - JILL KALMAN | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Cardiovascular Disease Physician (207RC0000X) |
United | 43239 | $915.74 | 1326482555 - EVAN LEVINE | 133884168 - WESTCHESTER MEDICAL GROUP, P.C. D/B/A WESTMED MEDICAL GROUP | NY | Cardiovascular Disease Physician (207RC0000X) |
United | 43239 | $2096.33 | 1023470309 - ADAM GOLDEN | 135562308 - NEW YORK UNIVERSITY | NY | Surgical Critical Care Physician (2086S0102X) |
United | 43239 | $479.87 | 1811027998 - KELLY EBERHARDT | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Pediatrics Physician (208000000X) |
United | 43239 | $915.74 | 1841339702 - AMANDA GANEM | 133884168 - WESTCHESTER MEDICAL GROUP, P.C. D/B/A WESTMED MEDICAL GROUP | NY | Cardiovascular Disease Physician (207RC0000X) |
United | 43239 | $741.28 | 1619987120 - THIERRY DUCHATELLIER | 113613997 - CHS PHYSICIAN PARTNERS PC | NY | Cardiovascular Disease Physician (207RC0000X) |
United | 43239 | $77.06 | 1376598136 - YELENA BIRGER | 320505032 - YELENA BIRGER DO PC | NJ | Internal Medicine Physician (207R00000X) |
United | 43239 | $394.79 | 1285801019 - FERAS ALDAOUD | 841991156 - (AZ) NEXT GEN MEDICUS | AZ | Internal Medicine Physician (207R00000X) |
United | 43239 | $1736.05 | 1518314095 - DAVID RHEE | 135562308 - NEW YORK UNIVERSITY | NY | Internal Medicine Physician (207R00000X) |
United | 43239 | $350.79 | 1588657365 - MANOJ MAKHIJA | 465267258 - (AZ) SUNRISE MEDICAL ASSOCIATES, LLC | AZ | Internal Medicine Physician (207R00000X) |
United | 43239 | $1193.46 | 1497910186 - RAHUL KUMAR | 411761760 - FAIRVIEW CLINICS | AZ | Internal Medicine Physician (207R00000X) |
United | 43239 | $1362.60 | 1356428437 - MARCO DI TULLIO | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Cardiovascular Disease Physician (207RC0000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 43239 vs. Other Endoscopy Procedures on the Esophagus Codes
The CPT 43239 code is part of the Esophagogastroduodenoscopy Procedures services used for Endoscopy Procedures on the Esophagus. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 43239 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 43198-CPT | Moderate | Esophagus Exam With Scope, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy). |
| 43210-CPT | Moderate | Scope Exam Of Stomach, Examination Of The Esophagus Stomach And Small Intestine Using A Scope (Endoscope). The Procedure Includes Tightening The Junction Between The Esophagus And The Stomach. |
| 43235-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; Diagnostic Including Collection Of Specimen(S) Bybrushing Or Washing When Performed (Separate Procedure) (Revised 01/01/2014) |
| 43239-CPT | Moderate | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Biopsy Single Or Multiple |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43239. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43239 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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