The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 43291. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
33
Median % of Medicare
72.4%
Rate range
$105.77 - $948.19
43291 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $286.51 | -- | -- | 2026 |
| Arkansas | $145.69 | 28.8% | -- | 2026 |
| Arizona | $458.85 | 90.6% | -- | 2025 |
| Colorado | $136.83 | 27% | Required | 2026 |
| Connecticut | $367.04 | 72.4% | Required | 2026 |
| District of Columbia | $467.94 | 92.4% | Not required | 2026 |
| Delaware | $491.57 | 97% | -- | 2026 |
| Georgia | $387.42 | 76.5% | -- | 2026 |
| Hawaii | $160.16 | 31.6% | -- | 2025 |
| Idaho | $405.19 | 80% | Not required | 2026 |
| Illinois | $105.77 | 20.9% | -- | 2024 |
| Indiana | $417.27 | 82.4% | Required | 2025 |
| Kansas | $268.05 | 52.9% | -- | 2024 |
| Kentucky | $369.52 | 72.9% | -- | 2026 |
| Massachusetts | $362.34 | 71.5% | -- | 2025 |
| Maine | $340.62 | 67.2% | -- | 2026 |
| Michigan | $323.12 | 63.8% | -- | 2026 |
| Missouri | $455.90 | 90% | Not required | 2023 |
| Mississippi | $403.20 | 79.6% | -- | 2026 |
| Montana | $611.26 | 120.6% | -- | 2026 |
| North Dakota | $562.86 | 111.1% | Not required | 2026 |
| Nebraska | $266.76 | 52.6% | -- | 2026 |
| New Hampshire | $267.05 | 52.7% | Required | 2026 |
| New Jersey | $260.60 | 51.4% | Not required | 2026 |
| New Mexico | $631.11 | 124.6% | -- | 2025 |
| Nevada | $199.31 | 39.3% | -- | 2024 |
| New York | $307.53 | 60.7% | -- | 2026 |
| Ohio | $342.27 | 67.6% | -- | 2023 |
| Oregon | $410.92* | 81.1% | -- | 2026 |
| Rhode Island | $948.19 | -- | -- | 2026 |
| Virginia | $438.95 | 86.6% | -- | 2026 |
| West Virginia | $333.30 | 65.8% | -- | 2026 |
| Wyoming | $389.22* | 76.8% | -- | 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 43291?
33 state Medicaid programs publish a fee-for-service rate for 43291 (upper GI endoscopy with stomach balloon removal), ranging from $105.77 in Illinois to $948.19 in Rhode Island, with a median of 72.4% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 43291?
Rhode Island publishes the highest Medicaid rate for 43291 at $948.19. Illinois publishes the lowest at $105.77.
Does 43291 require prior authorization under Medicaid?
4 of the 33 publishing states flag 43291 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".