The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 43290. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
30
Median % of Medicare
73.4%
Rate range
$122.74 - $3,501.61
43290 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $1,155.37 | -- | -- | 2026 |
| Arkansas | $161.94 | 6.1% | -- | 2026 |
| Arizona | $2,463.35 | 92.3% | -- | 2025 |
| Colorado | $153.60 | 5.8% | Required | 2026 |
| Connecticut | $1,990.38 | 74.6% | Required | 2026 |
| District of Columbia | $2,504.35 | 93.8% | Not required | 2026 |
| Delaware | $2,586.88 | 96.9% | -- | 2026 |
| Georgia | $2,257.90 | 84.6% | -- | 2026 |
| Hawaii | $176.84 | 6.6% | -- | 2025 |
| Illinois | $122.74 | 4.6% | -- | 2024 |
| Indiana | $2,352.90 | 88.2% | Required | 2025 |
| Kansas | $1,504.93 | 56.4% | -- | 2024 |
| Kentucky | $2,104.79 | 78.9% | -- | 2026 |
| Massachusetts | $131.59 | 4.9% | -- | 2025 |
| Maine | $1,780.86 | 66.7% | -- | 2026 |
| Michigan | $1,701.87 | 63.8% | -- | 2026 |
| Missouri | $2,643.11 | 99% | Not required | 2023 |
| Mississippi | $2,081.15 | 78% | -- | 2026 |
| Montana | $3,289.45 | 123.3% | -- | 2026 |
| Nebraska | $296.40 | 11.1% | -- | 2026 |
| New Hampshire | $1,450.06 | 54.3% | Required | 2026 |
| New Jersey | $1,381.80 | 51.8% | Not required | 2026 |
| New Mexico | $3,501.61 | 131.2% | -- | 2025 |
| Nevada | $230.15 | 8.6% | -- | 2024 |
| New York | $1,801.26 | 67.5% | -- | 2026 |
| Ohio | $1,959.14 | 73.4% | -- | 2023 |
| Oregon | $2,175.75* | 81.5% | -- | 2026 |
| Virginia | $2,311.92 | 86.6% | -- | 2026 |
| West Virginia | $1,707.51 | 64% | -- | 2026 |
| Wyoming | $2,105.43* | 78.9% | -- | 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
- 10004 - Needle biopsy without imaging, each added lesion
- 10005 - Needle biopsy with ultrasound guidance, first lesion
- 10006 - Needle biopsy with ultrasound guidance, each added lesion
- 10007 - Needle biopsy with fluoroscopic guidance, first lesion
- 10009 - Needle biopsy with CT guidance, first lesion
- 10011 - Needle biopsy with MRI guidance, first lesion
- 10012 - Needle biopsy with MRI guidance, each added lesion
- 10021 - Fine needle aspiration biopsy, first lesion, no imaging
Frequently asked questions
How much does Medicaid pay for 43290?
30 state Medicaid programs publish a fee-for-service rate for 43290 (upper GI endoscopy with stomach balloon placement), ranging from $122.74 in Illinois to $3,501.61 in New Mexico, with a median of 73.4% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 43290?
New Mexico publishes the highest Medicaid rate for 43290 at $3,501.61 (131.2% of the national Medicare amount). Illinois publishes the lowest at $122.74.
Does 43290 require prior authorization under Medicaid?
4 of the 30 publishing states flag 43290 as requiring prior authorization (always or conditionally) on their fee schedules. States without a flag publish no PA indicator for this code - that means "not published", not "no PA required".