Is CPT 43239 overcharged?
43239: Upper GI endoscopy with biopsy (Procedure)
Approximate Medicare national rate
Source: CMS Physician Fee Schedule CY2026, Oct release (national, non-facility). National amount; actual Medicare payment varies by locality. Facility-setting physician rate: $123.58 (hospital facility fee billed separately).
Hospital outpatient facility rate (OPPS, APC 5301)
Source: CMS OPPS Addendum B, October 2026. At a hospital you usually get two bills: the facility fee (compare to this) and the physician fee (compare to $123.58).
What's a reasonable charge?
Commercial insurers typically pay roughly 1.5 to 2.5 times Medicare. If you were billed more than $1256.55 for 43239, ask for an itemized bill, request the provider's cash price, and dispute the difference.
Check your whole bill
Duplicates and unbundling are often worth more than a single high price. Scan your bill free