CPT 43239: upper endoscopy (EGD) with biopsy. What Medicare pays and what to ask
An upper endoscopy with biopsy produces charges from several providers. Here is what 43239 covers and the Medicare rate.
What this code means
CPT 43239 is an upper endoscopy: a flexible camera passed through the mouth to look at the esophagus, the stomach and the first part of the small intestine, with one or more biopsies.
The tissue samples are sent to a lab, which bills separately, often with 88305.
Why the bill can be much higher than the Medicare rate
The rate shown is the doctor's fee. The facility, the anesthesia and the pathology lab are billed separately.
A procedure without a biopsy has a different code.
| If a line is billed at | It would be |
|---|---|
| 5x the Medicare rate | $2,094.25 |
| 10x the Medicare rate | $4,188.50 |
| 20x the Medicare rate | $8,377.00 |
The Medicare rate is a published benchmark, not a legal ceiling on what a provider may charge. Our free scan flags a line as worth a closer look when it is billed at more than 10 times the Medicare rate.
Questions worth asking before you pay
- Was a biopsy actually taken, and does the code match?
- What are the separate charges for the facility, anesthesia and pathology?
- How many specimens went to the lab?
Check every line against the official Medicare rates in about a minute. The scan is free.
Related codes
Source: Medicare Physician Fee Schedule (CMS, July 2026 release), national payment amount, non-facility setting. Last updated October 2026. This page is general information, not legal or medical advice. Rates change each year and a hospital bill can include charges that the benchmark does not cover.