$348.83–$366.93
Use 43235 for diagnostic EGD, with or without brushings or washings. Report 43239 instead when a forceps biopsy is taken.
On this page
CMS RVU26D · Effective 2026-10-01
43239 EGD with biopsy Medicare reimbursement rates in New Jersey
Report one EGD with biopsy when tissue is sampled from the esophagus, stomach, or duodenum, regardless of the number of biopsy sites. Compare 43239 office and facility rates across CMS payment localities in New Jersey.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 43239 in New Jersey?
New Jersey has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$453.38–$477.48
2 of 2 localities have a supported rate.
Facility setting
$130.95–$134.98
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Gastrointestinal endoscopy
About 43239: Upper GI endoscopy with biopsy, single or multiple
Report one EGD with biopsy when tissue is sampled from the esophagus, stomach, or duodenum, regardless of the number of biopsy sites.
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.
CMS billing rules for 43239
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.33 · 19%
- Practice expense (office) RVU9.94 · 79%
- Malpractice RVU0.27 · 2%
1.6M
Medicare services in 2024 · #96 by national volume
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 compared with similar codes
Office rates for New Jersey, from the same CMS release.
$590.18–$620.94
43251 describes snare removal of a lesion. Use 43239 for forceps tissue sampling or cold-forceps removal of a small lesion.
$426.41–$449.94
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.
No office rate
43238 uses endoscopic ultrasound to guide needle sampling through the esophageal wall. Use 43239 for mucosal forceps biopsy during EGD.
Compare 43239 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Northern Nj →
Office / nonfacility
$477.48
Facility
$134.98
Rest Of New Jersey →
Office / nonfacility
$453.38
Facility
$130.95
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,16443236,,Uppr gi scope w/submuc inj,A,,2.33,10.76,,1.10,,0.27,13.36,3.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16543237,,Endoscopic us exam esoph,A,,3.38,1.42,NA,1.42,,0.38,5.18,5.18,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16643238,,Egd us fine needle bx/aspir,A,,4.06,1.62,NA,1.62,,0.44,6.12,6.12,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16743239,,Egd biopsy single/multiple,A,,2.33,9.94,,1.10,,0.27,12.54,3.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16843240,,Egd w/transmural drain cyst,A,,6.97,2.48,NA,2.48,,0.79,10.24,10.24,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16943241,,Egd tube/cath insertion,A,,2.43,1.07,NA,1.07,,0.30,3.80,3.80,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17043242,,Egd us fine needle bx/aspir,A,,4.61,1.78,NA,1.78,,0.49,6.88,6.88,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00