An upper endoscopy, or EGD (esophagogastroduodenoscopy), passes a thin camera through the mouth to look at the esophagus, stomach and the first part of the small intestine. CPT 43235 is the diagnostic version with no biopsy. It takes about 15 minutes under sedation and is done for reflux, swallowing problems, unexplained pain or bleeding.
What the price covers
The hospital's price is the facility fee for the endoscopy unit: room, nursing, scope, sedation monitoring and recovery. The gastroenterologist and the anesthesia provider bill separately. If a sample is taken the code becomes 43239 and pathology is added.
Why prices vary
An EGD is one of the most variable codes in hospital price files. Large systems and academic centers commonly list gross charges several times higher than community hospitals, and cash discounts range from 20 to 70 percent. Freestanding endoscopy centers, which do not publish these files, are often the cheapest option of all.
Questions to ask
- What is the self-pay price for 43235, and does it include the physician and anesthesia?
- What will it cost if a biopsy is taken (43239)?
- Is the procedure done in the hospital or in a hospital-owned outpatient center, and are the prices the same?