# CPT 43235: Upper GI endoscopy, diagnostic (esophagus, stomach, duodenum)

Medicare CPT 43235 pays $322.65 in a non-facility setting and $110.56 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $284.01 in Arkansas to $371.11 in District of Columbia, a 31% spread.

Web page: https://www.med-reveal.com/rates/43235-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Gastroenterology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $322.65 |
| National facility | $110.56 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| District of Columbia | $371.11 | $121.27 |
| Alaska | $369.14 | $143.26 |
| California | $366.60 | $115.64 |
| New Jersey | $357.88 | $119.07 |
| Washington | $357.62 | $115.83 |
| New York | $357.26 | $120.65 |
| Massachusetts | $353.79 | $115.49 |
| Hawaii | $353.05 | $111.90 |
| Connecticut | $344.68 | $116.25 |
| Colorado | $337.49 | $111.82 |
| Maryland | $334.64 | $113.53 |
| Oregon | $334.17 | $110.73 |
| New Hampshire | $331.76 | $110.97 |
| Rhode Island | $331.22 | $112.12 |
| Florida | $331.06 | $118.26 |
| Puerto Rico | $325.24 | $110.82 |
| Virgin Islands | $325.24 | $110.82 |
| Minnesota | $324.16 | $105.91 |
| Montana | $322.64 | $110.54 |
| Illinois | $321.87 | $116.94 |
| Nevada | $321.56 | $109.25 |
| Wyoming | $320.57 | $108.47 |
| Delaware | $319.23 | $109.68 |
| Pennsylvania | $318.77 | $111.02 |
| Texas | $318.64 | $109.83 |
| North Dakota | $317.89 | $105.80 |
| South Dakota | $317.33 | $105.23 |
| Vermont | $316.23 | $106.25 |
| Virginia | $316.11 | $107.62 |
| Arizona | $313.86 | $108.34 |
| Georgia | $312.99 | $110.65 |
| Michigan | $310.88 | $111.73 |
| Maine | $308.69 | $106.03 |
| Utah | $307.05 | $107.68 |
| Wisconsin | $306.75 | $103.56 |
| New Mexico | $303.80 | $109.31 |
| North Carolina | $303.24 | $105.36 |
| South Carolina | $302.72 | $106.74 |
| Missouri | $302.23 | $107.60 |
| Louisiana | $301.59 | $107.94 |
| Ohio | $301.27 | $107.63 |
| Indiana | $300.54 | $103.93 |
| Idaho | $298.71 | $103.58 |
| Nebraska | $298.69 | $102.92 |
| Iowa | $296.87 | $102.80 |
| Tennessee | $296.51 | $103.71 |
| Kansas | $295.01 | $103.28 |
| Kentucky | $294.61 | $106.06 |
| Oklahoma | $294.49 | $105.09 |
| West Virginia | $293.82 | $109.51 |
| Alabama | $288.36 | $102.78 |
| Mississippi | $286.30 | $103.68 |
| Arkansas | $284.01 | $101.82 |

## Related codes

- 40490: Biopsy of lip — https://www.med-reveal.com/rates/40490-cpt-fee-schedule
- 40650: Repair lip, vermilion only — https://www.med-reveal.com/rates/40650-cpt-fee-schedule
- 41010: Frenotomy, lingual — https://www.med-reveal.com/rates/41010-cpt-fee-schedule
- 41112: Excision of lesion of tongue — https://www.med-reveal.com/rates/41112-cpt-fee-schedule
- 41599: Unlisted procedure, tongue/floor of mouth — https://www.med-reveal.com/rates/41599-cpt-fee-schedule
- 42700: Incision and drainage of peritonsillar abscess — https://www.med-reveal.com/rates/42700-cpt-fee-schedule
- 42820: Tonsillectomy and adenoidectomy, under age 12 — https://www.med-reveal.com/rates/42820-cpt-fee-schedule
- 42821: Tonsillectomy and adenoidectomy, age 12 or over — https://www.med-reveal.com/rates/42821-cpt-fee-schedule

Commercial negotiated rates for 43235 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules