CPT code 43200: Esophagoscopy, flexible scope with brushings2026 Medicare rate & RVUs in Texas
Reports flexible transoral examination of the esophagus when the clinician collects cells or material by brushing or washing during the procedure.
Medicare pays $265.37–$299.77 for 43200 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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.
Where 43200 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$265.37 to $299.77
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $299.77 | $80.32 |
| Beaumont, TX | $265.37 | $76.62 |
| Brazoria, TX | $283.64 | $78.08 |
| Dallas, TX | $285.40 | $78.81 |
| Fort Worth, TX | $283.15 | $78.63 |
| Galveston, TX | $284.44 | $78.47 |
| Houston, TX | $288.28 | $82.32 |
| Rest of Texas | $274.31 | $77.47 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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%).
43200 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43202Esophageal biopsyFlexible transoral scope
- Use 43200 for brush or wash collection; use 43202 when forceps are used to obtain esophageal tissue for biopsy.
- 43235Upper GI endoscopyDiagnostic, brushings or washings
- 43200 examines the esophagus. Choose 43235 when the endoscopic examination extends through the stomach and includes the duodenum.
- 43231Esophageal EUSExamination only, esophagus
- 43231 includes endoscopic ultrasound evaluation of the esophagus; 43200 is an inspection with brush or wash sampling.
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
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