CPT 43239: what Medicare pays in 2026

Medicare amounts for 43239 in 2026

Doctor's office or clinic, national

$418.85

Doctor's bill for hospital or surgery-center care, national

$123.58

Hospital outpatient rate, national (APC 5301)

$926.63

Hospital outpatient status T

separately paid procedure (second and later procedures of this type at half rate)

Same-day global period: routine care on the day of the procedure is included. Hospital outpatient rates are national figures before Medicare's wage adjustment, which moves about 60% of the rate up or down with local hospital wages.

What providers charged Medicare for 43239 in 2024

From CMS's national utilization file (the most recent full year published). The charge is the provider's list price, the same kind of figure an uninsured patient is usually billed.

How Medicare builds the 43239 amount

Each physician fee schedule amount is three relative value units (RVUs), each multiplied by the locality's cost index, added up and multiplied by the 2026 conversion factor of $33.4009.

Work RVU

2.33

Practice expense RVU, office

9.94

Practice expense RVU, facility

1.10

Malpractice RVU

0.27

43239 in every Medicare locality

The office amount is lowest in Arkansas and highest in San Jose-Sunnyvale-Santa Clara (San Benito County), CA. The facility amount runs from $114.03 to $160.83.

Other digestive system procedure codes

• 45380
• 45385