# CPT 43242: Egd Intrmural Needle Aspir/biop Altered Anatomy

Medicare CPT 43242 pays $229.80 in a non-facility setting and $229.80 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $213.48 in Arkansas to $303.30 in Alaska, a 42% spread.

Web page: https://www.med-reveal.com/rates/43242-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Gastroenterology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $229.80 |
| National facility | $229.80 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $303.30 | $303.30 |
| District of Columbia | $250.55 | $250.55 |
| New York | $249.86 | $249.86 |
| New Jersey | $246.57 | $246.57 |
| Florida | $245.49 | $245.49 |
| Illinois | $243.24 | $243.24 |
| Connecticut | $240.89 | $240.89 |
| Washington | $239.52 | $239.52 |
| Massachusetts | $238.97 | $238.97 |
| California | $238.72 | $238.72 |
| Maryland | $235.60 | $235.60 |
| Rhode Island | $232.92 | $232.92 |
| Michigan | $232.84 | $232.84 |
| Colorado | $231.87 | $231.87 |
| Pennsylvania | $231.10 | $231.10 |
| Hawaii | $231.05 | $231.05 |
| Georgia | $230.51 | $230.51 |
| Puerto Rico | $230.21 | $230.21 |
| Virgin Islands | $230.21 | $230.21 |
| New Hampshire | $230.19 | $230.19 |
| Montana | $229.77 | $229.77 |
| Oregon | $229.69 | $229.69 |
| West Virginia | $229.06 | $229.06 |
| Texas | $228.56 | $228.56 |
| Delaware | $228.20 | $228.20 |
| New Mexico | $228.15 | $228.15 |
| Nevada | $227.12 | $227.12 |
| Arizona | $225.60 | $225.60 |
| Wyoming | $225.54 | $225.54 |
| Louisiana | $225.40 | $225.40 |
| Ohio | $224.76 | $224.76 |
| Missouri | $224.65 | $224.65 |
| Utah | $224.56 | $224.56 |
| Virginia | $223.98 | $223.98 |
| South Carolina | $222.82 | $222.82 |
| Kentucky | $221.81 | $221.81 |
| Vermont | $221.12 | $221.12 |
| Maine | $221.04 | $221.04 |
| North Dakota | $220.08 | $220.08 |
| Minnesota | $220.00 | $220.00 |
| North Carolina | $219.91 | $219.91 |
| Oklahoma | $219.79 | $219.79 |
| South Dakota | $218.93 | $218.93 |
| Mississippi | $217.26 | $217.26 |
| Indiana | $217.05 | $217.05 |
| Tennessee | $216.81 | $216.81 |
| Idaho | $216.42 | $216.42 |
| Wisconsin | $215.98 | $215.98 |
| Kansas | $215.97 | $215.97 |
| Alabama | $215.26 | $215.26 |
| Nebraska | $215.04 | $215.04 |
| Iowa | $214.88 | $214.88 |
| Arkansas | $213.48 | $213.48 |

## Related codes

- 10140: I&d Hematoma Seroma/fluid Collection — https://www.med-reveal.com/rates/10140-cpt-fee-schedule
- 11055: Paring/cutting Benign Hyperkeratotic Lesion 1 — https://www.med-reveal.com/rates/11055-cpt-fee-schedule
- 11056: Paring/cutting Benign Hyperkeratotic Lesion 2-4 — https://www.med-reveal.com/rates/11056-cpt-fee-schedule
- 11057: Paring/cutting Benign Hyperkeratotic Lesion >4 — https://www.med-reveal.com/rates/11057-cpt-fee-schedule
- 11403: Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l 2.1-3.0 Cm — https://www.med-reveal.com/rates/11403-cpt-fee-schedule
- 11404: Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l 3.1-4.0 Cm — https://www.med-reveal.com/rates/11404-cpt-fee-schedule
- 11406: Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l >4.0 Cm — https://www.med-reveal.com/rates/11406-cpt-fee-schedule
- 11603: Excision Mal Lesion Trunk/arm/leg 2.1-3.0 Cm — https://www.med-reveal.com/rates/11603-cpt-fee-schedule

Commercial negotiated rates for 43242 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