Upper endoscopy: how much does Medicare pay?

Nationally, the Q3 2026 Physician Fee Schedule pays $418.85 in an office (non-facility) setting and $123.58 in a facility setting for 43239. Your local amount differs — the national figure applies geographic index values of 1.000, and Medicare then pays 80% of the allowed amount after the deductible is met.

Procedure · Updated Aug 1, 2026

Upper endoscopy: CPT code and Medicare rate

An examination of the esophagus, stomach, and upper small bowel with a flexible scope, with one or more biopsies taken — the most commonly billed upper endoscopy.

Also called: egd, endoscopy, scope of the stomach, gastroscopy.

Usually billed as

43239 Upper GI Endoscopy (EGD) with Biopsy

Office (non-facility): $418.85
Facility: $123.58

National amounts for the Q3 2026 release (July 1 – September 30, 2026), using geographic index values of 1.000. Your local rate differs — open the code page for the locality breakdown.

When people say "endoscopy" without qualifying it, this upper study is usually what they mean. A scope of the colon is a colonoscopy.

Common questions

Upper endoscopy: which code is it?: 43239 — Upper GI Endoscopy (EGD) with Biopsy. An examination of the esophagus, stomach, and upper small bowel with a flexible scope, with one or more biopsies taken — the most commonly billed upper endoscopy.
Upper endoscopy: how much does Medicare pay?: Nationally, the Q3 2026 Physician Fee Schedule pays $418.85 in an office (non-facility) setting and $123.58 in a facility setting for 43239. Your local amount differs — the national figure applies geographic index values of 1.000, and Medicare then pays 80% of the allowed amount after the deductible is met.
Upper endoscopy: what else affects the billing?: When people say "endoscopy" without qualifying it, this upper study is usually what they mean. A scope of the colon is a colonoscopy.

Need the rate where you practice?

Every code page carries the full locality breakdown, the RVU and GPCI inputs, and the release that answered.

Open the code page

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This page maps everyday language to the code a claim normally carries. It is general information about how Medicare prices a service, not coding advice for a specific claim — the correct code always depends on what was actually documented and performed.

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