CPT code 43239: EGD with biopsy, single or multiple biopsies2026 Medicare rate & RVUs in New York, New York
CPT 43239: $482.90–$494.31 office ($139.24–$143.24 facility) across 3 localities in New York, NY in 2026 Medicare. Compare each area.
Medicare pays $482.90–$494.31 for 43239 in the office in New York, New York, from Manhattan, NY to NYC suburbs and Long Island, NY. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 6 sections
Where 43239 pays more and less in New York, New York
New York, New York maps to 3 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
3 payment localities
$482.90 to $494.31
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $482.90 | $139.80 |
| NYC suburbs and Long Island, NY | $494.31 | $143.24 |
| Queens, NY | $488.24 | $139.24 |
How payment areas work in New York
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- NYC suburbs / Long Island · Bronx County, Kings County, Richmond County
- Manhattan · New York County
- Queens · Queens County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
How the 43239 rate is calculated
Each of 43239’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43239
RVUs × geographic indexes × conversion factor
Work2.33
2.33 RVUs× 1.000 GPCI
Practice expense9.94
9.94 RVUs× 1.000 GPCI
Malpractice0.27
0.27 RVUs× 1.000 GPCI
Adjusted RVUs
12.5400
Conversion factor
$33.4009
Medicare rate
$418.85
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43239
The CMS indicators that decide how 43239 is paid alongside other services.
CMS payment indicators · 43239
EGD with biopsy, single or multiple biopsies
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43239 without 51 · national office
$418.85
EGD with biopsy, single or multiple biopsies
43239-51 · Second procedure: 50%
$209.43
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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