Billing code 43239: EGD with biopsyMedicare rate & RVUs in Nevada
Report one EGD with biopsy when tissue is sampled from the esophagus, stomach, or duodenum, regardless of the number of biopsy sites.
Medicare pays $417.67 for 43239 in the office in Nevada (Nevada**). 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 9 sections
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.
43239 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | $417.67 | $122.11 |
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
Swap in your local Medicare rate.
Work 2.33Practice expense 9.94Malpractice 0.27
All indexes start 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
| 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
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%).
43239 compared with similar codes
Compare codes
43239 vs 43235 vs 43251 vs 43202 vs 43238: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43235Upper GI endoscopy
- Use 43235 for diagnostic EGD, with or without brushings or washings. Report 43239 instead when a forceps biopsy is taken.
- 43251EGD lesion removal
- 43251 describes snare removal of a lesion. Use 43239 for forceps tissue sampling or cold-forceps removal of a small lesion.
- 43202Esophageal biopsy
- 43202 describes biopsy during an examination limited to the esophagus. Use 43239 when the upper GI examination extends into the stomach and a biopsy is taken.
- 43238EUS-guided biopsy
- 43238 uses endoscopic ultrasound to guide needle sampling through the esophageal wall. Use 43239 for mucosal forceps biopsy during EGD.
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
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