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See a sample rate comparisonCPT 43239 Fee Schedule
Last Verified: September 2026
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.
Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Biopsy Single Or Multiple
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 43239 |
National average reimbursement for CPT 43239 by major payers:
$431.86
$480.56
$538.52
$259.90
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CPT 43239
5 of 25 sample ratesHigher to lower in this preview
Margherita Bruni
North Shore-Lij Medical PC
$2,234.93Published rateAmanda Ganem
Westchester Medical Group, P.C. D/B/A Westmed Medical Group
$915.74Published rateRobin Jacobson
New York University
$650.77Published rateOmair Hasan
Peak Medical PLLC
$383.51Published rateYelena Birger
Yelena Birger Do PC
$77.06Published rate
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See a sample payer proposalCPT 43239 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43239 code is part of the Surgery services used for Surgical Procedures on the Digestive System. 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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