The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 43239. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export
- Full state Medicaid dental network lists
- Email alerts when a state changes its rates
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Publishing states
48
Median % of Medicare
72%
Rate range
$78.81 - $839.97
43239 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $661.87 | 158% | -- | 2026 |
| Alabama | $241.00 | 57.5% | -- | 2026 |
| Arkansas | $373.00 | 89.1% | -- | 2026 |
| Arizona | $405.78 | 96.9% | -- | 2022 |
| California | $234.18 | 55.9% | -- | 2026 |
| Colorado | $116.89 | 27.9% | -- | 2026 |
| Connecticut | $231.22 | 55.2% | -- | 2026 |
| District of Columbia | $386.54 | 92.3% | Not required | 2026 |
| Delaware | $406.05 | 96.9% | -- | 2026 |
| Florida | $96.12 | 22.9% | -- | 2026 |
| Georgia | $210.98 | 50.4% | -- | 2026 |
| Hawaii | $139.09 | 33.2% | -- | 2025 |
| Iowa | $311.31 | 74.3% | -- | 2024 |
| Idaho | $334.83 | 79.9% | Not required | 2026 |
| Illinois | $130.31 | 31.1% | -- | 2024 |
| Indiana | $342.36 | 81.7% | -- | 2025 |
| Kansas | $284.80 | 68% | -- | 2024 |
| Kentucky | $179.22 | 42.8% | -- | 2026 |
| Louisiana | $290.09 | 69.3% | -- | 2026 |
| Massachusetts | $296.27 | 70.7% | -- | 2025 |
| Maine | $281.55 | 67.2% | -- | 2026 |
| Michigan | $78.81 | 18.8% | -- | 2026 |
| Minnesota | $324.96 | 77.6% | -- | 2026 |
| Missouri | $295.49 | 70.5% | Not required | 2022 |
| Mississippi | $688.78 | 164.4% | -- | 2026 |
| Montana | $501.05 | 119.6% | -- | 2026 |
| North Carolina | $255.25 | 60.9% | -- | 2025 |
| North Dakota | $464.86 | 111% | Not required | 2026 |
| Nebraska | $318.62 | 76.1% | -- | 2026 |
| New Hampshire | $137.96 | 32.9% | Not required | 2026 |
| New Jersey | $291.64 | 69.6% | Not required | 2026 |
| New Mexico | $517.75 | 123.6% | -- | 2025 |
| Nevada | $179.49 | 42.9% | -- | 2024 |
| New York | $354.66 | 84.7% | -- | 2026 |
| Ohio | $281.85 | 67.3% | -- | 2024 |
| Oklahoma | $356.71 | 85.2% | -- | 2026 |
| Oregon | $339.49* | 81.1% | -- | 2026 |
| Pennsylvania | $148.58 | 35.5% | -- | 2010 |
| Rhode Island | $839.97 | 200.5% | -- | 2026 |
| South Carolina | $243.62 | 58.2% | -- | 2024 |
| Texas | $301.52* | 72% | -- | 2024 |
| Utah | $312.43* | 74.6% | Not required | 2026 |
| Virginia | $362.85* | 86.6% | -- | 2026 |
| Vermont | $351.19 | 83.8% | -- | 2026 |
| Washington | $259.32 | 61.9% | -- | 2026 |
| Wisconsin | $318.57 | 76.1% | -- | 2018 |
| West Virginia | $275.96 | 65.9% | -- | 2026 |
| Wyoming | $319.23 | 76.2% | -- | 2026 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related physician codes
- 10021 - Fine needle aspiration biopsy, first lesion, no imaging
- 10060 - Drainage of a skin abscess, simple
- 10061 - Drainage of a skin abscess, complicated or multiple
- 10120 - Removal of a foreign body from tissue, simple
- 10140 - Drainage of a blood or fluid collection under the skin
- 11042 - Wound debridement, skin and tissue below, first 20 sq cm
- 11043 - Wound debridement to muscle, first 20 sq cm
- 11044 - Wound debridement to bone, first 20 sq cm
Frequently asked questions
How much does Medicaid pay for 43239?
48 state Medicaid programs publish a fee-for-service rate for 43239 (upper GI endoscopy (EGD) with biopsy), ranging from $78.81 in Michigan to $839.97 in Rhode Island, with a median of 72% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 43239?
Rhode Island publishes the highest Medicaid rate for 43239 at $839.97 (200.5% of the national Medicare amount). Michigan publishes the lowest at $78.81.
Does 43239 require prior authorization under Medicaid?
No publishing state flags 43239 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.