#4763 of 11K

43246

Upper GI endoscopy with gastrostomy tube placement

Upper GI endoscopy with gastrostomy tube placement is the #4,763 most-billed Medicaid procedure code, with $416K in payments across 3K claims from 2018–2024. The national median cost per claim is $81.78. Costs vary widely — the 90th percentile is $171.91 per claim, 2.1× the median.

Total Paid

$416K

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$138

National Cost Distribution

How much do providers bill per claim for 43246? Based on 27 providers billing this code nationally.

Median

$81.78

Average

$107.57

Std Dev

$143.08

Max

$782.87

Percentile Distribution (Cost per Claim)

p10

$27.10

p25

$56.70

Median

$81.78

p75

$98.33

p90

$171.91

p95

$210.24

p99

$637.70

50% of providers bill between $56.70 and $98.33 per claim for this code.

90% bill between $27.10 and $171.91.

Top 1% bill above $637.70.

About This Procedure

HCPCS code 43246 (Upper GI endoscopy with gastrostomy tube placement) was billed by 29 providers across 3K claims, totaling $416K in Medicaid payments from 2018–2024. This code was used for 3K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$81.78

Providers Billing

National Spending

$416K

Avg/Median Ratio

1.32×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 43246

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology	$171K	$782.87	9.6× median	Top 1%
2	1740310689	$164K	$98.95	1.2× median	Above 75th
3	1386911006	$14K	$87.33	1.1× median	Above Median
4	1346324613	$14K	$81.78	1.0× median	Above Median
5	1447299797	$9K	$84.50	1.0× median	Above Median
6	1376528026	$8K	$60.04	0.7× median	Below Median
7	1326140153	$4K	$168.57	2.1× median	Above 75th
8	1134176480	$3K	$176.92	2.2× median	Top 10%
9	1063454692	$3K	$111.67	1.4× median	Above 75th
10	1093765604	$3K	$22.37	0.3× median	Below Median
11	1477655298	$3K	$224.53	2.7× median	Top 10%
12	1942328273	$3K	$98.42	1.2× median	Above 75th
13	1063845113	$2K	$37.77	0.5× median	Below Median
14	1073856720	$2K	$53.88	0.7× median	Below Median
15	1235147158	$2K	$88.93	1.1× median	Above Median
16	1306073994	$1K	$98.23	1.2× median	Above Median
17	1245220763	$1K	$64.72	0.8× median	Below Median
18	1528074812	$1K	$95.95	1.2× median	Above Median
19	1215240221	$1K	$76.98	0.9× median	Below Median
20	1982795472	$1K	$87.44	1.1× median	Above Median

Showing top 20 of 29 providers billing this code

Related Procedures

43239Upper GI endoscopy with biopsy$1.51B 43249Upper GI endoscopy with balloon dilation of esophagus$9.8M 43248$8.4M 43255Upper GI endoscopy with tissue ablation or removal$3.5M 43251$2.2M

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