43255
Upper GI endoscopy with tissue ablation or removal
Upper GI endoscopy with tissue ablation or removal is the #2,813 most-billed Medicaid procedure code, with $3.5M in payments across 7K claims from 2018–2024. The national median cost per claim is $51.37. Costs vary widely — the 90th percentile is $317.00 per claim, 6.2× the median.
Total Paid
$3.5M
0.00% of all spending
Total Claims
7K
Providers
10
Avg Cost/Claim
$475
National Cost Distribution
How much do providers bill per claim for 43255? Based on 10 providers billing this code nationally.
Median
$51.37
Average
$138.66
Std Dev
$226.04
Max
$736.12
Percentile Distribution (Cost per Claim)
50% of providers bill between $11.32 and $131.17 per claim for this code.
90% bill between $9.54 and $317.00.
Top 1% bill above $694.21.
About This Procedure
HCPCS code 43255 (Upper GI endoscopy with tissue ablation or removal) was billed by 10 providers across 7K claims, totaling $3.5M in Medicaid payments from 2018–2024. This code was used for 7K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$51.37
Providers Billing
10
National Spending
$3.5M
Avg/Median Ratio
2.70×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 43255
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1497011308 | $2.6M |
| 2 | 1326031923 | $861K |
| 3 | 1265489157 | $11K |
| 4 | 1316492887 | $3K |
| 5 | 1649489469 | $1K |
| 6 | Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent | $1K |
| 7 | 1104055425 | $1K |
| 8 | 1114092186 | $835 |
| 9 | 1831371749 | $476 |
| 10 | 1285030080 | $171 |
Showing top 10 of 10 providers billing this code