Gastroenterology Billing Services
Colonoscopy coding alone has multiple variations based on screening vs diagnostic, findings, and interventions performed. Add EGD, capsule endoscopy, and motility studies, and GI billing becomes one of the most complex specialties.
Why Gastroenterology Billing Requires Specialty Expertise
GI billing centers on endoscopy coding. When a screening colonoscopy (45378) finds a polyp, it becomes a diagnostic procedure with different coding and cost-sharing rules. Getting this conversion right affects both provider reimbursement and patient billing.
Common Gastroenterology CPT Codes
Our coders handle these gastroenterology codes daily. This is not an exhaustive list.
2026 Medicare Allowables for Gastroenterology CPT Codes by State
Medicare reimbursement for gastroenterologyprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same gastroenterology CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 9 core gastroenterologycodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.
Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.
| Code | Gastroenterology Procedure | CA | TX | FL | NY | PA | IL | OH | GA | NC | MI |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 43239 | Upper GI endoscopy with biopsy | $478.36 | $413.49 | $428.49 | $464.16 | $413.37 | $416.13 | $390.04 | $405.47 | $393.35 | $402.27 |
| 43235 | Diagnostic upper GI endoscopy (EGD) | $366.60 | $318.64 | $331.06 | $357.26 | $318.76 | $321.87 | $301.27 | $312.99 | $303.24 | $310.88 |
| 43248 | EGD with esophageal dilation over guide wire | $520.59 | $452.19 | $469.85 | $507.16 | $452.36 | $456.73 | $427.42 | $444.12 | $430.26 | $441.10 |
| 45378 | Diagnostic colonoscopy | $422.96 | $373.71 | $391.92 | $417.90 | $374.71 | $382.23 | $355.75 | $369.07 | $355.86 | $367.93 |
| 45380 | Colonoscopy with biopsy | $541.86 | $474.18 | $494.42 | $530.98 | $474.81 | $481.34 | $449.63 | $466.80 | $451.45 | $464.33 |
| 45385 | Colonoscopy with polypectomy by snare | $558.77 | $494.44 | $517.25 | $551.81 | $495.68 | $504.77 | $471.09 | $488.22 | $471.48 | $486.58 |
| 45390 | Colonoscopy with ablation of tumor or polyp | $300.53 | $288.68 | $311.04 | $315.69 | $292.05 | $308.30 | $284.18 | $291.51 | $277.60 | $294.72 |
| 91110 | Capsule endoscopy of esophagus through ileum | $936.67 | $791.22 | $807.56 | $890.80 | $788.26 | $780.76 | $739.11 | $769.58 | $752.53 | $759.20 |
| 99213 | Established patient office visit, low MDM | $104.31 | $94.46 | $98.20 | $103.97 | $94.79 | $96.44 | $90.97 | $93.60 | $90.84 | $93.44 |
Full Gastroenterology fee detail by state
2026 Medicare allowables for gastroenterology CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.
| Code | Description | Non-Facility | Facility |
|---|---|---|---|
| 43239 | Upper GI endoscopy with biopsy | $478.36 | $128.98 |
| 43235 | Diagnostic upper GI endoscopy (EGD) | $366.60 | $115.64 |
| 43248 | EGD with esophageal dilation over guide wire | $520.59 | $153.82 |
| 45378 | Diagnostic colonoscopy | $422.96 | $170.41 |
| 45380 | Colonoscopy with biopsy | $541.86 | $184.18 |
| 45385 | Colonoscopy with polypectomy by snare | $558.77 | $231.52 |
| 45390 | Colonoscopy with ablation of tumor or polyp | $300.53 | $300.53 |
| 91110 | Capsule endoscopy of esophagus through ileum | $936.67 | $936.67 |
| 99213 | Established patient office visit, low MDM | $104.31 | $59.65 |
Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.
Gastroenterology Billing Challenges We Solve
Common billing problems in gastroenterology and how our team handles them.
Screening to Diagnostic Conversion
When a screening colonoscopy finds pathology, the coding changes. This affects cost-sharing and requires correct diagnosis code sequencing.
Multiple Procedure Endoscopy
When both colonoscopy and EGD are done same session, specific modifier and code rules apply.
Facility vs Professional
ASC vs office-based endoscopy has different coding and reimbursement rules.
Polyp Removal Technique
Snare (45385), hot biopsy (45384), and cold biopsy have different codes and RVUs.
Common Gastroenterology Denial Reasons
We prevent these before submission and appeal aggressively when they occur.
Revenue Opportunities Most Gastroenterology Practices Miss
Payer-Specific Gastroenterology Billing Tips
Gastroenterology Billing Best Practices
Practical tips from our coding team to maximize reimbursement and minimize denials.
Get Expert Gastroenterology Billing Support
Free billing assessment for your gastroenterology practice. See where revenue is leaking.
What We Handle for Gastroenterology Practices
Why Choose Go Medical Billing for Gastroenterology
Our GI coders understand screening-to-diagnostic conversion, polyp removal technique coding, and the multi-procedure rules that apply when both upper and lower endoscopy are performed.
We serve gastroenterology practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.
Gastroenterology Billing by State
We handle gastroenterology billing in all 50 states. The 2026 Medicare allowables for gastroenterology CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.
Frequently Asked Questions
Get Expert Gastroenterology Billing Support
Stop losing revenue to gastroenterology coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.