# CPT 43248: Upper GI endoscopy with insertion of guide wire for dilation

Medicare CPT 43248 pays $457.93 in a non-facility setting and $147.97 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $402.83 in Arkansas to $526.94 in District of Columbia, a 31% spread.

Web page: https://www.med-reveal.com/rates/43248-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Gastroenterology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $457.93 |
| National facility | $147.97 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| District of Columbia | $526.94 | $161.80 |
| Alaska | $523.12 | $193.01 |
| California | $520.59 | $153.82 |
| New Jersey | $508.07 | $159.04 |
| Washington | $507.76 | $154.41 |
| New York | $507.16 | $161.38 |
| Massachusetts | $502.29 | $154.05 |
| Hawaii | $501.33 | $148.90 |
| Connecticut | $489.29 | $155.46 |
| Colorado | $479.09 | $149.29 |
| Maryland | $474.99 | $151.85 |
| Oregon | $474.37 | $147.82 |
| New Hampshire | $470.93 | $148.26 |
| Rhode Island | $470.11 | $149.92 |
| Florida | $469.85 | $158.85 |
| Puerto Rico | $461.62 | $148.25 |
| Virgin Islands | $461.62 | $148.25 |
| Minnesota | $460.13 | $141.18 |
| Montana | $457.90 | $147.94 |
| Illinois | $456.73 | $157.23 |
| Nevada | $456.38 | $146.11 |
| Wyoming | $454.97 | $145.01 |
| Delaware | $453.03 | $146.79 |
| Pennsylvania | $452.36 | $148.75 |
| Texas | $452.19 | $147.03 |
| North Dakota | $451.18 | $141.22 |
| South Dakota | $450.39 | $140.43 |
| Vermont | $448.80 | $141.94 |
| Virginia | $448.61 | $143.92 |
| Arizona | $445.39 | $145.04 |
| Georgia | $444.12 | $148.42 |
| Michigan | $441.10 | $150.05 |
| Maine | $438.04 | $141.87 |
| Utah | $435.67 | $144.30 |
| Wisconsin | $435.30 | $138.35 |
| New Mexico | $431.02 | $146.78 |
| North Carolina | $430.26 | $141.07 |
| South Carolina | $429.49 | $143.09 |
| Missouri | $428.79 | $144.35 |
| Louisiana | $427.86 | $144.87 |
| Ohio | $427.42 | $144.42 |
| Indiana | $426.41 | $139.08 |
| Idaho | $423.80 | $138.64 |
| Nebraska | $423.78 | $137.69 |
| Iowa | $421.18 | $137.57 |
| Tennessee | $420.66 | $138.91 |
| Kansas | $418.53 | $138.33 |
| Kentucky | $417.92 | $142.37 |
| Oklahoma | $417.76 | $140.97 |
| West Virginia | $416.75 | $147.39 |
| Alabama | $409.03 | $137.82 |
| Mississippi | $406.07 | $139.20 |
| Arkansas | $402.83 | $136.57 |

## 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 43248 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