CPT 43239: Upper Endoscopy (EGD) with Biopsy
CPT 43239 reports an esophagogastroduodenoscopy (EGD) with biopsy, single or multiple, per session, examining the esophagus, stomach, and duodenum. In 2026 Medicare pays about $418.85 non-facility and $123.58 facility, with a 000-day global period.
- Code type
- Surgical - EGD with biopsy (single/multiple)
- 2026 non-facility
- $418.85
- 2026 facility
- $123.58
- Global period
- 000 days
What is CPT 43239 used for?
CPT 43239 reports an esophagogastroduodenoscopy (EGD) with biopsy, single or multiple. A flexible scope is passed through the mouth to visualize the esophagus, stomach, and duodenum, and one or more tissue samples are taken with biopsy forceps. It is the most common therapeutic EGD code.
If no tissue is sampled, the diagnostic code 43235 applies instead. Other interventions during the same scope, such as dilation or control of bleeding, have their own codes and follow the endoscopic base-code family rules.
How much does 43239 pay in 2026?
Under the 2026 Medicare fee schedule, 43239 allows about $418.85 non-facility and $123.58 facility for the professional service.
| Setting | 2026 Medicare allowed |
|---|---|
| Non-facility | ~$418.85 |
| Facility (ASC/hospital) | ~$123.58 |
Example: a gastroenterologist performs an EGD and takes three gastric biopsies for suspected H. pylori. You bill one unit of 43239 at about $123.58 in the facility for the professional fee. Check your locality figure with the Medicare fee calculator.
Why is 43239 always one unit?
The descriptor bundles all biopsies from the session into a single code, which trips up coders who think in terms of specimens:
- Perform the EGD and take one or more biopsies.
- Report a single unit of 43239, regardless of the number of biopsies.
- Do not add units for extra sites sampled during the same scope.
How does bundling and modifier 59 work?
When a second, distinct upper endoscopy service is performed at a separate anatomic site or for a distinct clinical reason, modifier 59 or an X-modifier may be needed to bypass an NCCI edit, but only with documentation proving the separation. Reporting both 43235 and 43239 for the same scope is unbundling. With a 000 global period, no post-op days are bundled. For lower GI endoscopy, see 45378.
Frequently asked questions
In 2026 the national non-facility allowed amount is about $418.85, and the facility rate is about $123.58. Most EGDs are done in a facility, so the physician typically receives the professional fee. Medicare pays 80 percent after the deductible.
One. 43239 is reported once per session regardless of how many biopsies are taken or how many sites are sampled. The descriptor says single or multiple, so additional biopsies from the same EGD do not add units.
43235 is a diagnostic EGD with no tissue sampling. 43239 is an EGD with biopsy. When a biopsy is taken, 43239 replaces 43235; you do not report both for the same scope. The presence of a biopsy is what separates them.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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