| Code | Description | States | Median rate |
|---|---|---|---|
| 43191 | Rigid esophagus scope, diagnostic | 48 | $110.55 |
| 43192 | Rigid esophagus scope with injection | 47 | $123.78 |
| 43193 | Rigid esophagus scope with biopsy | 48 | $138.67 |
| 43194 | Rigid esophagus scope with foreign body removal | 47 | $137.80 |
| 43195 | Rigid esophagus scope with balloon stretching | 48 | $144.03 |
| 43200 | Flexible esophagus scope, diagnostic | 48 | $195.80 |
| 43201 | Flexible esophagus scope with injection | 47 | $215.36 |
| 43202 | Flexible esophagus scope with biopsy | 48 | $263.59 |
| 43204 | Flexible esophagus scope with varices injection | 48 | $133.19 |
| 43205 | Flexible esophagus scope with varices banding | 48 | $135.93 |
| 43206 | Flexible esophagus scope with optical endomicroscopy | 32 | $263.47 |
| 43210 | Endoscopic anti-reflux surgery through the mouth (TIF) | 40 | $343.51 |
| 43211 | Flexible esophagus scope with lining (mucosal) resection | 47 | $189.07 |
| 43212 | Flexible esophagus scope with stent placement | 47 | $151.63 |
| 43215 | Esophagus scope with foreign body removal | 48 | $302.20 |
| 43229 | Esophagus scope with lesion ablation | 47 | $563.57 |
| 43231 | Esophagus scope with ultrasound | 47 | $147.60 |
| 43232 | Esophagus scope with ultrasound-guided needle biopsy | 47 | $181.00 |
| 43235 | Upper GI endoscopy (EGD), diagnostic | 48 | $243.95 |
| 43237 | Upper GI endoscopy with ultrasound, limited | 48 | $164.07 |
| 43238 | Upper GI endoscopy with ultrasound needle biopsy, limited | 47 | $197.03 |
| 43239 | Upper GI endoscopy (EGD) with biopsy | 48 | $296.27 |
| 43240 | Upper GI endoscopy with pancreatic pseudocyst drainage | 47 | $317.55 |
| 43241 | Upper GI endoscopy with tube or catheter placement | 47 | $124.69 |
| 43242 | Upper GI endoscopy with ultrasound-guided needle biopsy | 48 | $229.60 |
| 43243 | Upper GI endoscopy with varices injection | 48 | $212.83 |
| 43244 | Upper GI endoscopy with varices banding | 48 | $214.82 |
| 43246 | Upper GI endoscopy with feeding tube (PEG) placement | 48 | $190.21 |
| 43247 | Upper GI endoscopy with foreign body removal | 48 | $298.95 |
| 43249 | Upper GI endoscopy with balloon dilation of esophagus | 48 | $789.10 |
| 43250 | Upper GI endoscopy with removal of growths by hot forceps | 48 | $346.50 |
| 43251 | Upper GI endoscopy with removal of growths by snare | 47 | $390.19 |
| 43252 | Upper GI endoscopy with optical endomicroscopy | 34 | $289.97 |
| 43253 | Upper GI endoscopy with ultrasound-guided injection | 47 | $209.61 |
| 43254 | Upper GI endoscopy with lining (mucosal) resection | 47 | $212.88 |
| 43255 | Upper GI endoscopy with control of bleeding | 48 | $452.00 |
| 43257 | Upper GI endoscopy with heat treatment for reflux (Stretta) | 41 | $206.82 |
| 43259 | Upper GI endoscopy with full ultrasound exam | 48 | $207.74 |
| 43260 | ERCP (bile and pancreatic duct scope), diagnostic | 48 | $273.34 |
| 43261 | ERCP with biopsy | 48 | $289.03 |
| 43262 | ERCP with cutting of the bile duct opening | 48 | $322.72 |
| 43264 | ERCP with duct stone removal | 48 | $329.11 |
| 43265 | ERCP with duct stone crushing | 47 | $366.56 |
| 43266 | Upper GI endoscopy with stent placement | 47 | $176.10 |
| 43270 | Upper GI endoscopy with lesion ablation | 47 | $576.39 |
| 43274 | ERCP with duct stent placement | 48 | $373.64 |
| 43275 | ERCP with duct stent or object removal | 48 | $305.95 |
| 43276 | ERCP with duct stent exchange | 48 | $388.89 |
| 43277 | ERCP with duct balloon stretching | 48 | $307.86 |
| 43280 | Laparoscopic reflux surgery (fundoplication) | 48 | $876.74 |
| 43281 | Laparoscopic paraesophageal hernia repair, no mesh | 47 | $1,187.78 |
| 43282 | Laparoscopic paraesophageal hernia repair with mesh | 47 | $1,335.49 |
| 43283 | Laparoscopic esophagus lengthening (Collis) (add-on) | 46 | $123.91 |
| 43284 | Laparoscopic magnetic sphincter implant for reflux (LINX) | 35 | $553.78 |
| 43285 | Removal of a magnetic sphincter implant (LINX) | 36 | $559.57 |
| 43289 | Unlisted laparoscopic esophagus procedure | 11 | $2,059.78 |
| 43290 | Upper GI endoscopy with stomach balloon placement | 30 | $1,801.26 |
| 43291 | Upper GI endoscopy with stomach balloon removal | 33 | $364.69 |
| 43327 | Open anti-reflux surgery (fundoplication) | 47 | $659.30 |
| 43328 | Anti-reflux surgery (fundoplication) through the chest | 47 | $911.97 |
| 43332 | Open paraesophageal hernia repair, no mesh | 47 | $929.73 |
| 43333 | Open paraesophageal hernia repair with mesh | 47 | $1,018.16 |
| 43334 | Paraesophageal hernia repair through the chest, no mesh | 47 | $1,005.21 |
| 43335 | Paraesophageal hernia repair through the chest, with mesh | 47 | $1,080.82 |
| 43338 | Esophagus lengthening (Collis gastroplasty) (add-on) | 47 | $92.74 |
| 43410 | Repair of an esophagus wound, neck approach | 45 | $742.51 |
| 43415 | Repair of an esophagus wound, chest or abdominal approach | 46 | $1,860.15 |
| 43497 | Endoscopic esophagus muscle cut through the mouth (POEM) | 41 | $635.08 |
| 43499 | Unlisted esophagus procedure | 13 | $636.02 |
| 43501 | Opening the stomach to stitch a bleeding ulcer | 47 | $986.86 |
| 43502 | Opening the stomach to stitch a Mallory-Weiss tear | 47 | $1,106.88 |
| 43520 | Cutting the stomach outlet muscle (pyloromyotomy) | 47 | $535.25 |
| 43605 | Open stomach biopsy | 47 | $621.89 |
| 43610 | Local removal of a stomach ulcer or benign tumor | 47 | $724.67 |
| 43620 | Total stomach removal with esophagus-to-bowel connection | 46 | $1,446.10 |
| 43621 | Total stomach removal with Roux-en-Y reconstruction | 46 | $1,628.30 |
| 43622 | Total stomach removal with bowel pouch | 46 | $1,652.33 |
| 43631 | Partial stomach removal with duodenum connection | 46 | $1,096.35 |
| 43632 | Partial stomach removal with jejunum connection | 46 | $1,457.38 |
| 43633 | Partial stomach removal with Roux-en-Y reconstruction | 46 | $1,380.34 |
| 43634 | Partial stomach removal with bowel pouch | 45 | $1,519.32 |
| 43644 | Gastric bypass, laparoscopic | 45 | $1,313.86 |
| 43645 | Laparoscopic gastric bypass with long-limb reconstruction | 42 | $1,394.50 |
| 43647 | Laparoscopic stomach stimulator lead placement | 26 | $634.37 |
| 43648 | Laparoscopic stomach stimulator lead revision or removal | 27 | $647.64 |
| 43659 | Unlisted laparoscopic stomach procedure | 14 | $1,818.97 |
| 43752 | Feeding tube placed through the nose with fluoroscopy | 43 | $33.03 |
| 43753 | Stomach tube placement and suction, therapeutic | 48 | $17.23 |
| 43762 | Replacement of a stomach feeding tube, simple | 48 | $184.96 |
| 43770 | Laparoscopic adjustable gastric band placement | 46 | $839.60 |
| 43771 | Laparoscopic gastric band component revision | 44 | $941.21 |
| 43772 | Laparoscopic gastric band component removal | 44 | $705.14 |
| 43773 | Laparoscopic gastric band component replacement | 45 | $955.74 |
| 43774 | Laparoscopic gastric band and port removal | 44 | $711.93 |
| 43775 | Sleeve gastrectomy, laparoscopic | 45 | $889.17 |
| 43800 | Stomach outlet widening (pyloroplasty) | 46 | $685.51 |
| 43840 | Stitching a perforated stomach or duodenal ulcer | 46 | $989.47 |
| 43842 | Open vertical banded gastroplasty | 38 | $871.81 |
| 43845 | Duodenal switch weight-loss surgery, open | 37 | $1,478.79 |
| 43846 | Open gastric bypass, short-limb Roux-en-Y | 44 | $1,203.52 |
| 43847 | Open gastric bypass with long-limb reconstruction | 42 | $1,311.50 |
| 43848 | Open revision of weight-loss surgery, not band | 42 | $1,414.77 |
| 43880 | Closure of a stomach-to-colon fistula | 47 | $1,163.05 |
| 43881 | Open stomach stimulator lead placement | 17 | $571.64 |
| 43882 | Open stomach stimulator lead revision or removal | 18 | $586.07 |
| 43886 | Open gastric band port revision | 44 | $292.52 |
| 43887 | Open gastric band port removal | 44 | $260.92 |
| 43888 | Open gastric band port replacement | 44 | $360.91 |
| 43999 | Unlisted stomach procedure | 11 | $817.60 |
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. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.