HCPCS 43239

Procedure (ClaimLight category; the code descriptor is not shown)

Procedures Work RVU per service 2.39 (2021 fee schedule)

17,240
98th percentile among 6,253 codes billed · 2021
$225M
99th percentile among 6,253 codes billed · 2021
1.7M
97th percentile among 6,253 codes billed · 2021
65
81st percentile among 6,253 codes billed · 2021
294
75th percentile among 6,253 codes billed · 2021
+14.4%
Medicare payment on the code vs 2020; billers +2.8% · 2021

Trend

Medicare payment on the code

$0$100M$200M2020: $197M paid20202021: $225M paid20212022: $213M paid20222023: $202M paid20232024: $209M paid2024$209M$0$100M$200M2020: $197M paid20202021: $225M paid20212022: $213M paid20222023: $202M paid20232024: $209M paid2024$209M$0$100M$200M2020: $197M paid20202021: $225M paid20212022: $213M paid20222023: $202M paid20232024: $209M paid2024$209M$0$100M$200M2020: $197M paid20202021: $225M paid20212022: $213M paid20222023: $202M paid20232024: $209M paid2024$209M

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

Billers

010K2020: 17K providers20202021: 17K providers20212022: 17K providers20222023: 17K providers20232024: 17K providers202417K010K2020: 17K providers20202021: 17K providers20212022: 17K providers20222023: 17K providers20232024: 17K providers202417K010K2020: 17K providers20202021: 17K providers20212022: 17K providers20222023: 17K providers20232024: 17K providers202417K010K2020: 17K providers20202021: 17K providers20212022: 17K providers20222023: 17K providers20232024: 17K providers202417K

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

observed calculated calculated calculated calculated calculated reported
202417,191$209,306,859+4%1,596,641602712.39
202317,140$201,872,979-5%1,603,452612772.39
202217,093$212,795,258-6%1,635,009632792.39
202117,240$225,489,880+14%1,714,975652942.39
202016,773$197,171,247first year in data1,531,820602662.39

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

By state

observed calculated calculated calculated calculated calculated
California1,498$27,132,825172,75076367
Florida1,244$24,019,315179,54788470
New York1,277$19,986,705107,34054222
Texas1,189$15,202,736124,29272273
New Jersey611$12,205,56671,54983358
Pennsylvania886$9,406,99872,07958227
North Carolina566$7,472,74058,25666335
Illinois660$7,283,31165,31773274
Maryland369$7,249,13548,98285459
Ohio705$6,739,47457,14855223
Georgia488$6,627,88750,77670298
Arizona343$5,428,51638,21269389
Michigan512$4,883,58241,43155251
South Carolina272$4,864,10539,51694463
Tennessee359$4,526,30138,93875298

Not listed: 2 billers with an armed-forces or unknown state code (ZZ); they are in the national totals.

Not listed: 3 states with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Providers placed by practice address. Data year 2021.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ1,383$25,193,244129,62660
Los Angeles-Long Beach-Anaheim, CA555$9,862,25663,12871
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD449$5,805,11640,46167
Miami-Fort Lauderdale-West Palm Beach, FL331$4,956,05134,66456
Chicago-Naperville-Elgin, IL-IN493$4,900,35645,73574
Washington-Arlington-Alexandria, DC-VA-MD-WV321$4,811,77233,97669
Dallas-Fort Worth-Arlington, TX357$4,300,88135,12369
Phoenix-Mesa-Chandler, AZ238$4,005,28327,41071
Atlanta-Sandy Springs-Roswell, GA272$3,815,57927,60168
Houston-Pasadena-The Woodlands, TX291$3,467,60727,14168
San Francisco-Oakland-Fremont, CA183$3,367,60119,30976
Baltimore-Columbia-Towson, MD181$3,360,67923,33283
Boston-Cambridge-Newton, MA-NH351$3,065,37925,99756
Tampa-St. Petersburg-Clearwater, FL189$2,972,48422,80284
Detroit-Warren-Dearborn, MI221$2,718,38721,66864

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 100 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2021.

Specialties billing 43239 nationally

Ambulatory Surgical Center accounts for 55% of payment for 43239 nationally in 2021, across 9 specialties on claims.

observed calculated calculated calculated calculated calculated
Ambulatory Surgical Center1,79010%$125,089,02455%494,876276
Gastroenterology12,21771%$88,802,86739%1,078,87488
General Surgery2,13212%$5,607,0802.5%73,45634
Internal Medicine8134.7%$5,005,9432.2%57,21370
Family Practice1030.60%$199,7840.09%2,24322
Colorectal Surgery (Proctology)520.30%$124,3750.06%1,76034
Thoracic Surgery350.20%$98,0670.04%1,28237
General Practice200.12%$76,1780.03%72636
Hospitalist150.09%$55,1080.02%75450

Not listed: 23 specialties with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Provider-level lines (fewer than 11 beneficiaries suppressed by CMS); specialty is the provider type on claims. Data year 2021.

Top billers of 43239 nationally

Named top billers are a Pro figure, and Pro is not available to buy, so this list is not shown to any account. The counts and totals by state, metro area and specialty on this page are free.

Original Medicare Part B fee-for-service only; CMS suppresses provider lines with fewer than 11 beneficiaries. How these figures are computed · Limitations