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CPT code 43239: EGD with biopsy, single or multiple biopsies2026 Medicare rate & RVUs in Vermont

Report one EGD with biopsy when tissue is sampled from the esophagus, stomach, or duodenum, regardless of the number of biopsy sites.

CMS RVU26DEffective Oct 1, 2026One payment locality1.6M Medicare services in 2024

In Vermont, Medicare pays $411.07 for 43239 in the office and $118.76 when it’s performed in a hospital or facility.

$411.07Office (non-facility)
$118.76Hospital or facility
−1.9%vs the national office rate ($418.85)

Check a contract rate as a % of Medicare · 43239 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 43239 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Vermont
  2. What 43239 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 43239 covers

The endoscopist passes a flexible scope through the mouth to examine the upper digestive tract and takes tissue samples with biopsy forceps. Common reasons include gastric sampling for Helicobacter pylori, duodenal sampling for suspected celiac disease, esophageal sampling for eosinophilic esophagitis, and Barrett's esophagus surveillance. Gastroenterologists and some surgeons perform the procedure, primarily in hospital outpatient departments and ambulatory surgery centers, but also in offices.

Report one unit for the EGD session regardless of the number of biopsies or sites sampled. The procedure note should identify the sampled sites and endoscopic findings; a pathologist's tissue examination is billed separately. CMS assigns a 0-day global period, which includes same-day preprocedure and postprocedure care. When another procedure in the same endoscopy family is separately reportable, endoscopy family pricing pays the highest-valued procedure in full and reduces the other procedure's payment by the diagnostic base endoscopy value. Modifier 50 is inappropriate for this procedure. An assistant surgeon is not paid, and co-surgeon or team-surgery billing is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Vermont compares for 43239

Across 109 of 109 payment localities, the office rate for 43239 runs from $367.66 in Arkansas to $569.97 in San Benito County, CA. Vermont pays $411.07. The RVUs are the same everywhere; the geographic indexes change the dollars.

43239 in Vermont vs other payment areas
  1. Vermont · this page$411.07
  2. Los Angeles, CA · California$479.76+$68.69
  3. Washington, DC area · District of Columbia$483.17+$72.10
  4. Miami, FL · Florida$446.25+$35.18
  5. Chicago, IL · Illinois$432.73+$21.66
  6. Manhattan, NY · New York$482.90+$71.83
  7. Alaska · Alaska$475.29+$64.22

Other areas in Vermont first, then benchmark localities. Bars start at $0.

Every other payment area

43239 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$373.43$115.08
ArkansasArkansas$367.66$114.03
ArizonaArizona$407.26$121.15
Bakersfield, CACalifornia$448.67$125.06
Chico, CACalifornia$447.86$124.25
El Centro, CACalifornia$447.90$124.29
Fresno, CACalifornia$447.86$124.25
Hanford, CACalifornia$447.86$124.25

43239 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$367.66

$508.92

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
43239 office rate range by state
State / territoryOffice rate rangeLocalities
AK$475.291
AL$373.431
AR$367.661
AZ$407.261
CA$447.86–$569.9729
CO$439.051
CT$447.861
DC$483.171
DE$414.341
FL$408.78–$446.253
GA$384.72–$426.212
GU$460.541
HI$460.541
IA$385.191
ID$387.531
IL$395.04–$435.324
IN$389.981
KS$382.501
KY$381.231
LA$380.29–$400.492
MA$435.86–$485.462
MD$422.87–$483.173
ME$388.88–$412.532
MI$391.13–$413.412
MN$422.131
MO$372.80–$402.933
MS$370.341
MT$418.831
NC$393.351
ND$413.491
NE$387.671
NH$431.331
NJ$453.38–$477.482
NM$393.101
NV$417.671
NY$399.57–$494.315
OH$390.041
OK$381.311
OR$414.84–$454.642
PA$391.13–$435.602
PR$422.361
RI$430.311
SC$392.261
SD$412.861
TN$384.461
TX$388.33–$437.238
UT$398.011
VA$410.55–$483.172
VI$422.361
VT$411.071
WA$435.30–$496.452
WI$398.661
WV$379.241
WY$416.501

See 43239 in every payment locality

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

Office or facility?

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.

The exact Vermont inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,167

Code
43239
Physician work
2.33
Practice expense
9.94
Malpractice
0.27

GPCI2026.csv

105

Locality
Vermont
Physician work
1.000
Practice expense
0.990
Malpractice
0.506
Office calculation for 43239 in Vermont
ComponentRVULocality factorAdjusted
Physician work2.33× 1.0002.3300
Practice expense9.94× 0.9909.8406
Malpractice0.27× 0.5060.1366
Total RVUs12.3072
Conversion factor× 33.4009

Office rate, Vermont$411.07

Office: (2.33 × 1 + 9.94 × 0.99 + 0.27 × 0.506) × $33.4009 = $411.07

Facility: (2.33 × 1 + 1.1 × 0.99 + 0.27 × 0.506) × $33.4009 = $118.76

Open 43239 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 43239

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 43239
CodeHow it relatesOffice range, Vermont
Same family
43235Upper GI endoscopy, diagnostic, brushings or washingsDiagnostic EGD base code; included in the biopsy procedure and not reported separately for the same examination.$316.23
Often billed with
43251EGD lesion removal, snare techniqueSnare removal of a separate lesion during the same EGD may be separately reportable with a modifier.$535.14
43249Esophageal dilation, balloon under 30 mmEsophageal balloon dilation under 30 mm may accompany biopsies during an EGD for dysphagia.$1,164.60
88305Tissue pathology exam, level IV specimenPathologist's tissue examination of biopsy specimens, billed separately.$69.36
00731Upper GI endoscopy, non-ERCP procedureAnesthesia for upper GI endoscopy when an anesthesia provider delivers the anesthetic.No office rate
45380Colonoscopy with biopsy, single or multiple forceps biopsiesColonoscopy with biopsy may be performed in the same session when both tracts require sampling.$469.54
Used instead
43202Esophageal biopsy, flexible transoral scopeBiopsy during esophagoscopy limited to the esophagus, without examination of the stomach.$386.36
43238EUS-guided biopsy, limited upper GI examinationUltrasound-guided needle sampling through the esophageal wall rather than mucosal forceps biopsy.No office rate

How 43239 has changed in Vermont

43239 · Office / nonfacility

$411.07

Effective 2026-10-01

The base rate is $60.38 higher than on 2025-10-01, moving from $350.69 to $411.07 (17.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $350.69changed to$411.07

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.39 changed to 2.33
    • Practice expense RVU 8.36 changed to 9.94
    • Malpractice RVU 0.29 changed to 0.27
    • Practice expense GPCI 0.993 changed to 0.990
    • Malpractice GPCI 0.518 changed to 0.506

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $368.67changed to$350.69

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.59 changed to 8.36
    • Malpractice RVU 0.30 changed to 0.29

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $362.65changed to$368.67

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $378.91changed to$362.65

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.66 changed to 8.59
    • Malpractice RVU 0.29 changed to 0.30
    • Practice expense GPCI 0.997 changed to 0.993
    • Malpractice GPCI 0.543 changed to 0.518

  5. January 1, 2023

    RVU23A

    $398.75changed to$378.91

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 8.97 changed to 8.66
    • Malpractice RVU 0.27 changed to 0.29
    • Practice expense GPCI 1.001 changed to 0.997
    • Malpractice GPCI 0.569 changed to 0.543

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $397.32changed to$398.75

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 8.84 changed to 8.97
    • Malpractice RVU 0.26 changed to 0.27

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $381.71changed to$397.32

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.96 changed to 8.84
    • Malpractice RVU 0.28 changed to 0.26
    • Practice expense GPCI 1.008 changed to 1.001
    • Malpractice GPCI 0.582 changed to 0.569

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $366.61changed to$381.71

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.48 changed to 7.96
    • Malpractice RVU 0.32 changed to 0.28
    • Practice expense GPCI 1.015 changed to 1.008
    • Malpractice GPCI 0.595 changed to 0.582

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $351.38changed to$366.61

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.08 changed to 7.48
    • Malpractice RVU 0.31 changed to 0.32

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $347.57changed to$351.38

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.02 changed to 7.08
    • Malpractice RVU 0.32 changed to 0.31
    • Practice expense GPCI 1.010 changed to 1.015
    • Malpractice GPCI 0.639 changed to 0.595

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $401.21changed to$347.57

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.49 changed to 2.39
    • Practice expense RVU 8.45 changed to 7.02
    • Malpractice RVU 0.34 changed to 0.32
    • Practice expense GPCI 1.004 changed to 1.010
    • Malpractice GPCI 0.682 changed to 0.639

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $409.64changed to$401.21

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.63 changed to 8.45
    • Malpractice RVU 0.36 changed to 0.34

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $407.61changed to$409.64

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $402.69changed to$407.61

    • Conversion factor 35.8228 changed to 35.7547
    • Work RVU 2.47 changed to 2.49
    • Practice expense RVU 8.51 changed to 8.63
    • Malpractice RVU 0.34 changed to 0.36
    • Practice expense GPCI 1.006 changed to 1.004
    • Malpractice GPCI 0.618 changed to 0.682

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$402.69

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$411.07$118.76RVU26D
2026-07-01$411.07$118.76RVU26C
2026-04-01$411.07$118.76RVU26B
2026-01-01$411.07$118.76RVU26A
2025-10-01$350.69$127.78RVU25D
2025-07-01$350.69$127.78RVU25C
2025-04-01$350.69$127.78RVU25B
2025-01-01$350.69$127.78RVU25A
2024-10-01$368.67$131.34RVU24D
2024-07-01$368.67$131.34RVU24C
2024-04-01$368.67$131.34RVU24B
2024-03-09$368.67$131.34RVU24AR
2024-01-01$362.65$129.19RVU24A
2023-10-01$378.91$132.95RVU23D
2023-07-01$378.91$132.95RVU23C
2023-04-01$378.91$132.95RVU23B
2023-01-01$378.91$132.95RVU23A
2022-10-01$398.75$135.83RVU22D
2022-07-01$398.75$135.83RVU22C
2022-04-01$398.75$135.83RVU22B
2022-01-01$398.75$135.83RVU22A
2021-10-01$397.32$136.41RVU21D
2021-07-01$397.32$136.41RVU21C
2021-04-01$397.32$136.41RVU21B
2021-01-01$397.32$136.41RVU21A
2020-10-01$381.71$140.15RVU20D
2020-07-01$381.71$140.15RVU20C
2020-04-01$381.71$140.15RVU20B
2020-01-01$381.71$140.15RVU20A
2019-10-01$366.61$142.01RVU19D
2019-07-01$366.61$142.01RVU19C
2019-04-01$366.61$142.01RVU19B
2019-01-01$366.61$142.01RVU19A
2018-10-01$351.38$142.37RVU18D
2018-07-01$351.38$142.37RVU18C
2018-04-01$351.38$142.37RVU18B
2018-01-01$351.38$142.37RVU18AR1
2017-10-01$347.57$142.77RVU17D
2017-07-01$347.57$142.77RVU17C
2017-04-01$347.57$142.77RVU17B
2017-01-01$347.57$142.77RVU17A
2016-10-01$401.21$147.78RVU16D
2016-07-01$401.21$147.78RVU16C
2016-04-01$401.21$147.78RVU16B
2016-01-01$401.21$147.78RVU16A
2015-10-01$409.64$150.25RVU15D
2015-07-01$409.64$150.25RVU15C
2015-04-01$407.61$149.50RVU15B
2015-01-01$407.61$149.50RVU15A
2014-10-01$402.69$147.90RVU14D
2014-07-01$402.69$147.90RVU14C
2014-04-01$402.69$147.90RVU14B
2014-01-01$402.69$147.90RVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 43239 for an earlier date of service

Where the Vermont rate applies

Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.

  • Albany
  • Alburgh
  • Algiers
  • Arlington
  • Ascutney
  • Bakersfield
  • Barnet
  • Barre

Browse all communities in Vermont

43239 billing questions

How many units are reported when biopsies are taken from the esophagus, stomach, and duodenum?

One unit. The code covers single or multiple biopsies from any number of sites during the same EGD session.

Can the diagnostic EGD be billed along with the biopsy code?

No. Diagnostic EGD is included in the biopsy procedure and is not reported separately for the same examination.

Can a biopsy be billed with snare polypectomy during the same EGD?

Yes, if the biopsy samples a different lesion and both procedures are documented. Use a distinct-procedure modifier such as 59 or XS when needed; a biopsy of the lesion subsequently removed by snare is not separately reported.

How is payment calculated when a biopsy and a dilation are both done at the same EGD?

If both are separately reportable procedures in the same endoscopy family, the higher-valued procedure is paid in full. Payment for the other is reduced by the value of the diagnostic base endoscopy.

Is the pathology examination of the biopsy included?

No. The pathologist bills the tissue examination, typically with a surgical pathology code such as 88305, separately from the endoscopy.

Does the 0-day global period bundle a preprocedure office visit on an earlier date?

No. The 0-day global period includes same-day preprocedure and postprocedure care, not a visit on an earlier date.

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
RVUs for 43239PPRRVU2026_Oct_nonQPP.csv, line 5,167 (RVU26D)
Geographic factors for VermontGPCI2026.csv, line 105 (RVU26D)

Open CMS sourceHow we calculate rates

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