43239
Upper GI endoscopy with biopsy
Upper GI endoscopy with biopsy is the #127 most-billed Medicaid procedure code, with $1.51B in payments across 6.0M claims from 2018–2024. The national median cost per claim is $151.68. Costs vary widely — the 90th percentile is $447.20 per claim, 2.9× the median.
Total Paid
$1.51B
0.14% of all spending
Total Claims
6.0M
Providers
7K
Avg Cost/Claim
$254
National Cost Distribution
How much do providers bill per claim for 43239? Based on 6K providers billing this code nationally.
Median
$151.68
Average
$217.93
Std Dev
$229.42
Max
$4,745.13
Percentile Distribution (Cost per Claim)
50% of providers bill between $83.27 and $277.74 per claim for this code.
90% bill between $48.81 and $447.20.
Top 1% bill above $1,145.29.
About This Procedure
HCPCS code 43239 (Upper GI endoscopy with biopsy) was billed by 7K providers across 6.0M claims, totaling $1.51B in Medicaid payments from 2018–2024. This code was used for 5.5M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$151.68
Providers Billing
6K
National Spending
$1.51B
Avg/Median Ratio
1.44×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 43239
| # | Provider | Total Paid |
|---|---|---|
| 1 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $16.4M |
| 2 | Englewood Hospital And Medical Center Englewood, NJ · General Acute Care Hospital | $7.4M |
| 3 | Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology | $7.1M |
| 4 | Newark Beth Israel Medical Center Inc Newark, NJ · General Acute Care Hospital | $6.9M |
| 5 | 1760476659 | $6.8M |
| 6 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $6.6M |
| 7 | 1205853041 | $6.3M |
| 8 | Chinatown True Care Medical Pllc New York, NY · Family Medicine | $5.8M |
| 9 | Ahs Hospital Corp. Morristown, NJ · General Acute Care Hospital | $5.8M |
| 10 | Bakersfield Memorial Hospital Bakersfield, CA · General Acute Care Hospital | $5.7M |
| 11 | 1376774208 | $5.7M |
| 12 | 1558612762 | $5.4M |
| 13 | 1588938682 | $5.3M |
| 14 | Children's Hospital Corporation Boston, MA · Clinic/Center | $5.3M |
| 15 | 1780727636 | $5.2M |
| 16 | 1619166097 | $5.2M |
| 17 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $5.2M |
| 18 | Beth Israel Deaconess Medical Center, Inc. Boston, MA · General Acute Care Hospital | $5.1M |
| 19 | St Josephs University Medical Center Inc. Paterson, NJ · General Acute Care Hospital | $5.1M |
| 20 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $5.0M |
Showing top 20 of 7K providers billing this code