Upper Endoscopy (EGD) With Biopsy Cost
Egd biopsy single/multiple
$1,050Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
National Medicare physician rate (2026)
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.
Choosing a surgery centre over a hospital saves about $429 on the Medicare allowed amount for upper endoscopy (egd) with biopsy. Ask whether your procedure can be done at an ambulatory surgery centre.
This is Medicare's separate payment to the facility on top of the physician's fee. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Get the rate for your ZIP
CMS adjusts this CPT by locality. A five-digit ZIP is enough — no account, no insurance card.
What upper endoscopy (egd) with biopsy costs at hospitals near you
Everything above is a national average. The hospital you pick in your area moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. For this code the office and hospital physician lines differ by $295.27.
How CMS prices CPT 43239
Work is about 19% of the office total RVU; practice expense is about 79%. Localities with a high PE GPCI move this code more when practice expense is a large share.
Office vs hospital for this code
Office (non-facility) physician rate: $418.85. Hospital (facility) physician rate: $123.58.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible — about $84 for the office physician fee, before any Medigap coverage. That coinsurance does not include a hospital facility fee.
Labeled private-plan and cash ranges on this page are arithmetic multiples of Medicare, not negotiated quotes. Ask the billing office for the CPT code, the site of service, and a good-faith estimate.
What Is Upper Endoscopy (EGD) With Biopsy?
This is the same upper endoscopy camera exam of the esophagus, stomach, and duodenum, but with the physician taking one or more small tissue samples through the scope using tiny forceps. Biopsies are painless and are taken to test for conditions such as H. pylori infection, celiac disease, Barrett's esophagus, or inflammation. The exam runs 10 to 20 minutes under IV sedation, and recovery is the same as a diagnostic EGD: home the same day with a driver.
What Affects the Cost
- –Pathology is the defining extra cost of this code: each biopsy jar processed and read by the lab generates its own charge, and multiple sites mean multiple jars.
- –The facility fee difference between hospital outpatient departments and freestanding endoscopy centers dwarfs most other line items.
- –Separate anesthesia billing for propofol sedation adds an independent professional charge.
- –Testing biopsies for H. pylori or celiac disease may involve special stains that increase the lab bill.
- –The physician fee for 43239 is higher than the no-biopsy code 43235, reflecting the sampling work.
How It Is Billed
CPT 43239 includes taking biopsies, single or multiple, in one physician fee, so the number of samples does not change the doctor's charge; it changes the pathology lab's charge, which bills per specimen container. Expect distinct claims from the physician, the facility, the anesthesia provider, and the pathology lab. If a different therapeutic maneuver was also performed, such as dilating a narrowed esophagus, an additional or substituted code with higher payment applies.
Insurance & Coverage Notes
EGD with biopsy is diagnostic care covered under standard medical benefits with deductible and coinsurance; there is no scenario where it qualifies as free preventive screening. Prior authorization requirements mirror the diagnostic EGD, and the pathology claim is the one most likely to come from an unfamiliar, potentially out-of-network lab, so ask where specimens are sent. If your indication is surveillance of a known condition like Barrett's esophagus, coverage is routine but your cost sharing still applies each time.
Questions to Ask Before Booking
- 1.How many biopsy specimens do you expect to take, and what does the lab charge per specimen?
- 2.Which pathology lab reads the samples and is it in my network?
- 3.What is the total estimate across physician, facility, anesthesia, and pathology bills?
- 4.Would a freestanding endoscopy center lower the facility portion of my cost?
- 5.If you find something needing treatment during the exam, how could the code and price change?
Upper Endoscopy (EGD) With Biopsy (CPT 43239): questions
The 2026 national Medicare physician rate for CPT 43239 is $418.85 in an office and $123.58 in a hospital. Enter a ZIP code to apply the geographic adjustment for your locality.
Medicare uses a different practice-expense RVU in a facility. For CPT 43239 that produces an office rate of $418.85 and a hospital physician rate of $123.58 (a $295.27 gap). The hospital’s own facility charge is extra and often larger than this entire physician line.
This is the same upper endoscopy camera exam of the esophagus, stomach, and duodenum, but with the physician taking one or more small tissue samples through the scope using tiny forceps. Biopsies are painless and are taken to test for conditions such as H. pylori infection, celiac disease, Barrett's esophagus, or inflammation. The exam runs 10 to 20 minutes under IV sedation, and recovery is the same as a diagnostic EGD: home the same day with a driver. CMS bills it as “Egd biopsy single/multiple.”
Not on its own. $418.85 is the physician allowed amount. Medicare also pays the facility, which takes the total to about $1,050 in a hospital outpatient department or about $621 at an ambulatory surgery centre. Anesthesia, pathology and imaging interpretation billed under other codes are separate again. Private-plan allowed amounts are often higher than Medicare; your deductible and coinsurance still apply.
For cash-pay surgery shopping, use this CPT as the Medicare floor when you compare written quotes. How cash-price shopping works.