CPT 43239 is an upper endoscopy (EGD) in which tissue samples are taken from the esophagus, stomach or duodenum. It is the usual code when the exam is done to check for celiac disease, H. pylori, Barrett's esophagus or unexplained inflammation, since all of those need a sample to confirm.
What the price covers
The facility fee: the endoscopy room, nursing, the scope, biopsy forceps, sedation monitoring and recovery. Separately billed: the gastroenterologist, the anesthesia provider and the pathologist. Celiac work-ups often take four to six samples, so ask whether pathology is billed per specimen.
Related codes
- 43235: EGD, diagnostic, no biopsy
- 43239: EGD with biopsy (this page)
Hospitals typically price 43239 slightly above 43235. If only one is listed, it is a fair guide for the other.
Why prices vary
The spread within a metro area is usually several times. It tracks the hospital's overall pricing level, not the difficulty of the exam. Community hospitals and hospital-owned outpatient centers sit at the low end; academic medical centers at the high end.
Questions to ask
- What is the self-pay price for 43239 including pathology?
- How many samples are planned, and is pathology billed per sample?
- Who provides anesthesia, and what is their cash rate?