Egd diagnostic brush wash

What is CPT Code 43235?

Diagnostic upper GI endoscopy (EGD) without biopsy — visualization of the esophagus, stomach, and duodenum with a flexible scope. Used for diagnosis when no tissue sampling is required.

The Medicare reimbursement rate shown above is the amount the federal government has determined is a reasonable payment for this service. Hospitals and providers that participate in Medicare have agreed to accept these rates from Medicare patients.

Who typically bills this:Gastroenterologist + facility (ASC or hospital outpatient)

Common Billing Errors for CPT 43235

• !Billed alongside 43239 (EGD with biopsy) when a biopsy was taken — only the higher code should be billed
• !Facility fee and professional fee from the same entity billed as two line items without separation

Red Flags on Your Bill

Negotiation Tips for CPT 43235

1. 1If a biopsy was taken, the correct code is 43239 — not 43235 plus a biopsy code
2. 2The professional fee for an EGD at an ASC is typically 30–50% less than at a hospital
3. 3Ask for the self-pay discount upfront if you are uninsured — GI practices often have hardship programs

Codes That Often Appear With This One

These CPT codes commonly appear on the same bill. Review each one to spot potential bundling errors or duplicate charges.

Found CPT 43235 on Your Bill?

If you see CPT code 43235 on a hospital or medical bill, compare the charged amount to the Medicare rate above. If your bill shows a significantly higher charge, you may have grounds to negotiate.

1. Note the amount charged for CPT 43235 on your itemized bill
2. Compare it to the Medicare rate above — calculate the markup
3. Call the billing department and use the Medicare rate as your anchor:“I see CPT code 43235 billed at [amount]. The Medicare rate for this procedure is $290.79. I'd like to discuss a fair adjustment.”