HCPCS 43239

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

Procedures Work RVU per service 2.39 (2022 fee schedule)

17,093
98th percentile among 6,326 codes billed · 2022
$213M
99th percentile among 6,326 codes billed · 2022
1.6M
97th percentile among 6,326 codes billed · 2022
63
80th percentile among 6,326 codes billed · 2022
279
74th percentile among 6,326 codes billed · 2022
-5.6%
Medicare payment on the code vs 2021; billers -0.9% · 2022

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
California1,493$26,358,943169,04774351
Florida1,245$22,386,987169,23584460
New York1,287$19,344,011104,20353210
Texas1,210$14,501,932121,59070273
New Jersey613$11,550,91469,01077348
Pennsylvania884$8,905,55269,13356215
Maryland375$7,272,76449,65088482
North Carolina562$6,915,48954,68663295
Illinois660$6,880,66161,91568256
Georgia485$6,207,85848,29467291
Ohio671$6,145,42052,28355221
Arizona327$5,089,28836,08167383
Michigan514$4,497,05339,40251232
South Carolina267$4,474,65036,72991443
Massachusetts443$4,100,37234,60559212

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

Not listed: 2 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 2022.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ1,394$24,288,479126,86659
Los Angeles-Long Beach-Anaheim, CA539$9,807,17463,34773
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD446$5,513,89738,85163
Washington-Arlington-Alexandria, DC-VA-MD-WV317$4,952,02434,26669
Chicago-Naperville-Elgin, IL-IN493$4,705,99044,08170
Miami-Fort Lauderdale-West Palm Beach, FL335$4,686,18333,11154
Dallas-Fort Worth-Arlington, TX356$4,075,68133,74169
Phoenix-Mesa-Chandler, AZ239$3,872,71226,69965
Atlanta-Sandy Springs-Roswell, GA271$3,552,15326,05965
Houston-Pasadena-The Woodlands, TX306$3,319,84626,72959
Baltimore-Columbia-Towson, MD179$3,280,35823,02983
San Francisco-Oakland-Fremont, CA184$3,237,47518,70073
Boston-Cambridge-Newton, MA-NH343$2,860,47624,75454
Tampa-St. Petersburg-Clearwater, FL193$2,740,86821,58983
Detroit-Warren-Dearborn, MI219$2,569,23621,00565

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 2022.

Specialties billing 43239 nationally

Ambulatory Surgical Center accounts for 57% of payment for 43239 nationally in 2022, across 11 specialties on claims.

observed calculated calculated calculated calculated calculated
Ambulatory Surgical Center1,76910%$120,293,61457%475,433269
Gastroenterology12,24572%$82,014,48639%1,027,21784
General Surgery1,97112%$4,855,4572.3%65,74133
Internal Medicine8434.9%$4,779,6362.2%56,95068
Family Practice710.42%$155,1030.07%1,74025
Colorectal Surgery (Proctology)530.31%$116,0470.05%1,66131
Thoracic Surgery370.22%$95,5180.04%1,26734
Emergency Medicine130.08%$75,2510.04%1,03580
Hospitalist190.11%$72,5590.03%94550
General Practice180.11%$62,1260.03%62735
Vascular Surgery110.06%$23,0530.01%30227

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 2022.

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