Endoscopy

43239 - RVUs & Medicare payment (2026)

Upper GI endoscopy with biopsy.

Component	Non-facility	Facility
Work RVU	2.33	2.33
Practice expense RVU	9.94	1.10
Malpractice RVU	0.27	0.27
Total RVUs	12.54	3.70
National payment (CF $33.4009)	$418.85	$123.58
Qualifying APM payment (CF $33.5675)	$420.94	$124.20

How 43239 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 43239 ranges from $367.66 in Arkansas (AR) to $569.97 in San Jose-Sunnyvale-Santa Clara (CA); calculate 43239 for your locality.

San Jose-Sunnyvale-Santa Clara (CA) $569.97 San Jose-Sunnyvale-Santa Clara (CA) $568.72 San Francisco-Oakland-Berkeley (CA) $557.48 San Francisco-Oakland-Berkeley (CA) $557.18 Napa (CA) $524.89 Vallejo (CA) $524.45 Seattle (WA) $496.45 NYC Suburbs/Long Island (NY) $494.31 National average $418.85 … 97 more localities between … Alabama (AL) $373.43 Rest Of Missouri (MO) $372.80 Mississippi (MS) $370.34 Arkansas (AR) $367.66

Non-facility payment for 43239 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: 000

Same-day global period: related visits on the day of the procedure are included in the payment.

Related codes - endoscopy

45378 · colonoscopy, diagnostic
45380 · colonoscopy with biopsy
45385 · colonoscopy with snare polypectomy
G0121 · screening colonoscopy, not high risk (medicare)
G0105 · screening colonoscopy, high risk (medicare)
52000 · cystourethroscopy, diagnostic

Frequently asked questions

How much does Medicare pay for 43239 in 2026?

The national non-facility payment is $418.85 and the facility payment is $123.58, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 43239?

The 2026 work RVU for 43239 is 2.33. Total RVUs are 12.54 in the non-facility setting and 3.70 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.