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CPT code 43200: Esophagoscopy, flexible scope with brushings2026 Medicare rate & RVUs in Washington, DC area

Reports flexible transoral examination of the esophagus when the clinician collects cells or material by brushing or washing during the procedure.

CMS RVU26DEffective Oct 1, 2026One payment locality3.2K Medicare services in 2024

In Washington, DC area, Medicare pays $331.81 for 43200 in the office and $87.47 when it’s performed in a hospital or facility.

$331.81Office (non-facility)
$87.47Hospital or facility
+15.6%vs the national office rate ($286.91)

Check a contract rate as a % of Medicare · 43200 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 43200 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 43200 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 43200 covers

A flexible scope is passed through the mouth to examine the esophagus. During the examination, the clinician may brush or wash a mucosal area to collect cells or other material for laboratory analysis. Gastroenterologists commonly perform this service in an outpatient endoscopy unit or hospital; otolaryngologists may perform it in settings where they evaluate the esophagus. The code is limited to esophageal examination and sampling, rather than examination of the stomach or duodenum.

Report the service when documentation supports flexible transoral esophagoscopy and any brush or wash sampling performed. A forceps tissue biopsy is a different service. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery, co-surgeons, or a surgical team for this code.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Washington, DC area compares for 43200

Across 109 of 109 payment localities, the office rate for 43200 runs from $250.55 in Arkansas to $392.07 in San Benito County, CA. Washington, DC area pays $331.81. The RVUs are the same everywhere; the geographic indexes change the dollars.

43200 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$331.81
  2. Los Angeles, CA · California$329.23−$2.58
  3. Miami, FL · Florida$307.22−$24.59
  4. Chicago, IL · Illinois$297.49−$34.32
  5. Manhattan, NY · New York$331.85+$0.04
  6. Alaska · Alaska$322.01−$9.80
  7. Alabama · Alabama$254.64−$77.17

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

43200 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$250.55$72.37
ArizonaArizona$278.66$77.67
Bakersfield, CACalifornia$307.49$80.16
Chico, CACalifornia$306.89$79.56
El Centro, CACalifornia$306.92$79.59
Fresno, CACalifornia$306.89$79.56
Hanford, CACalifornia$306.89$79.56
Madera, CACalifornia$306.89$79.56

43200 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$250.55

$349.48

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
43200 office rate range by state
State / territoryOffice rate rangeLocalities
AK$322.011
AL$254.641
AR$250.551
AZ$278.661
CA$306.89–$392.0729
CO$300.891
CT$307.311
DC$331.811
DE$283.631
FL$280.15–$307.223
GA$263.01–$292.202
GU$315.991
HI$315.991
IA$262.811
ID$264.511
IL$270.52–$298.964
IN$266.241
KS$260.991
KY$260.371
LA$259.73–$274.072
MA$298.62–$333.392
MD$289.61–$331.813
ME$265.56–$282.222
MI$267.48–$283.542
MN$288.761
MO$254.47–$275.713
MS$252.581
MT$286.901
NC$268.721
ND$282.751
NE$264.551
NH$295.621
NJ$310.95–$327.702
NM$268.921
NV$285.981
NY$273.14–$340.065
OH$266.631
OK$260.331
OR$283.90–$311.812
PA$267.36–$298.682
PR$289.381
RI$294.751
SC$268.091
SD$282.261
TN$262.391
TX$265.37–$299.778
UT$272.171
VA$280.88–$331.812
VI$289.381
VT$281.111
WA$298.23–$341.012
WI$272.241
WV$259.311
WY$285.091

See 43200 in every payment locality

How the 43200 rate is calculated

Each of 43200’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 43200

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.38

1.38 RVUs× 1.000 GPCI

Practice expense7.00

7.00 RVUs× 1.000 GPCI

Malpractice0.21

0.21 RVUs× 1.000 GPCI

Adjusted RVUs

8.5900

Conversion factor

$33.4009

Medicare rate

$286.91

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,140

Code
43200
Physician work
1.38
Practice expense
7.00
Malpractice
0.21

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 43200 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.38× 1.0541.4545
Practice expense7.00× 1.1788.2460
Malpractice0.21× 1.1130.2337
Total RVUs9.9342
Conversion factor× 33.4009

Office rate, Washington, DC area$331.81

Office: (1.38 × 1.054 + 7 × 1.178 + 0.21 × 1.113) × $33.4009 = $331.81

Facility: (1.38 × 1.054 + 0.79 × 1.178 + 0.21 × 1.113) × $33.4009 = $87.47

Open 43200 in the RVU calculator

Payment rules and modifiers for 43200

The CMS indicators that decide how 43200 is paid alongside other services.

CMS payment indicators · 43200

Esophagoscopy, flexible scope with brushings

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43200 without 51 · national office

$286.91

Esophagoscopy, flexible scope with brushings

43200-51 · Second procedure: 50%

$143.46

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 43200

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 43200
CodeHow it relatesOffice range, Washington, DC area
Used instead
43202Esophageal biopsy, flexible transoral scopeUses forceps to obtain esophageal tissue rather than collecting a brush or wash specimen.$455.69
43235Upper GI endoscopy, diagnostic, brushings or washingsEvaluates the upper GI tract with a broader examination that includes the stomach and duodenum.$371.11
43231Esophageal EUS, examination only, esophagusAdds an ultrasound examination of the esophagus rather than brush or wash sampling.No office rate

How 43200 has changed in Washington, DC area

43200 · Office / nonfacility

$331.81

Effective 2026-10-01

The base rate is $37.81 higher than on 2025-10-01, moving from $294.00 to $331.81 (12.9%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $294.00changed to$331.81

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.42 changed to 1.38
    • Practice expense RVU 6.16 changed to 7.00
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $306.90changed to$294.00

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.26 changed to 6.16
    • Malpractice RVU 0.22 changed to 0.21

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $301.90changed to$306.90

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $319.99changed to$301.90

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.32 changed to 6.26
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $336.23changed to$319.99

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.43 changed to 6.32
    • Malpractice RVU 0.21 changed to 0.22
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $329.53changed to$336.23

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.21 changed to 6.43

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $295.22changed to$329.53

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.26 changed to 6.21
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $274.53changed to$295.22

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.86 changed to 5.26
    • Malpractice RVU 0.22 changed to 0.21
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $258.18changed to$274.53

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.49 changed to 4.86

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $258.48changed to$258.18

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.51 changed to 4.49
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $326.17changed to$258.48

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 1.52 changed to 1.42
    • Practice expense RVU 5.99 changed to 4.51
    • Malpractice RVU 0.23 changed to 0.22
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $327.81changed to$326.17

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.24 changed to 0.23

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $326.18changed to$327.81

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $322.12changed to$326.18

    • Conversion factor 35.8228 changed to 35.7547
    • Work RVU 1.50 changed to 1.52
    • Practice expense RVU 5.96 changed to 5.99
    • Malpractice RVU 0.21 changed to 0.24
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $260.01changed to$322.12

    • Conversion factor 34.0230 changed to 35.8228
    • Work RVU 1.59 changed to 1.50
    • Practice expense RVU 4.77 changed to 5.96
    • Malpractice RVU 0.23 changed to 0.21
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $260.01

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$331.81$87.47RVU26D
2026-07-01$331.81$87.47RVU26C
2026-04-01$331.81$87.47RVU26B
2026-01-01$331.81$87.47RVU26A
2025-10-01$294.00$94.66RVU25D
2025-07-01$294.00$94.66RVU25C
2025-04-01$294.00$94.66RVU25B
2025-01-01$294.00$94.66RVU25A
2024-10-01$306.90$97.40RVU24D
2024-07-01$306.90$97.40RVU24C
2024-04-01$306.90$97.40RVU24B
2024-03-09$306.90$97.40RVU24AR
2024-01-01$301.90$95.81RVU24A
2023-10-01$319.99$99.07RVU23D
2023-07-01$319.99$99.07RVU23C
2023-04-01$319.99$99.07RVU23B
2023-01-01$319.99$99.07RVU23A
2022-10-01$336.23$101.41RVU22D
2022-07-01$336.23$101.41RVU22C
2022-04-01$336.23$101.41RVU22B
2022-01-01$336.23$101.41RVU22A
2021-10-01$329.53$101.38RVU21D
2021-07-01$329.53$101.38RVU21C
2021-04-01$329.53$101.38RVU21B
2021-01-01$329.53$101.38RVU21A
2020-10-01$295.22$102.65RVU20D
2020-07-01$295.22$102.65RVU20C
2020-04-01$295.22$102.65RVU20B
2020-01-01$295.22$102.65RVU20A
2019-10-01$274.53$102.13RVU19D
2019-07-01$274.53$102.13RVU19C
2019-04-01$274.53$102.13RVU19B
2019-01-01$274.53$102.13RVU19A
2018-10-01$258.18$102.45RVU18D
2018-07-01$258.18$102.45RVU18C
2018-04-01$258.18$102.45RVU18B
2018-01-01$258.18$102.45RVU18AR1
2017-10-01$258.48$103.23RVU17D
2017-07-01$258.48$103.23RVU17C
2017-04-01$258.48$103.23RVU17B
2017-01-01$258.48$103.23RVU17A
2016-10-01$326.17$110.02RVU16D
2016-07-01$326.17$110.02RVU16C
2016-04-01$326.17$110.02RVU16B
2016-01-01$326.17$110.02RVU16A
2015-10-01$327.81$110.88RVU15D
2015-07-01$327.81$110.88RVU15C
2015-04-01$326.18$110.33RVU15B
2015-01-01$326.18$110.33RVU15A
2014-10-01$322.12$108.54RVU14D
2014-07-01$322.12$108.54RVU14C
2014-04-01$322.12$108.54RVU14B
2014-01-01$322.12$108.54RVU14A
2013-10-01$260.01$119.39RVU13D
2013-07-01$260.01$119.39RVU13C
2013-04-01$260.01$119.39RVU13B
2013-01-01$260.01$119.39RVU13AR

Price 43200 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

43200 billing questions

When should 43200 be chosen over 43202?

Choose 43200 when the esophageal specimen is collected by brushing or washing. Use 43202 when the clinician obtains tissue with forceps for biopsy.

Does the code include the brush or wash collection?

Yes. Brush or wash specimen collection during the esophagoscopy is included; do not report a separate service solely for that collection.

Can modifier 50 be used for this procedure?

No. Modifier 50 is inappropriate for this esophageal service.

How does Medicare handle same-session procedures?

The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple procedure reduction.

What same-day care is included in the global period?

The 0-day global period includes same-day preoperative and postoperative care.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 43200PPRRVU2026_Oct_nonQPP.csv, line 5,140 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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