CPT code 43202: Esophageal biopsy, flexible transoral scope2026 Medicare rate & RVUs in Sacramento, CA
Flexible esophagoscopy with forceps sampling of esophageal tissue is reported when examination is confined to the esophagus and tissue diagnosis is needed.
In Sacramento, CA, Medicare pays $445.68 for 43202 in the office and $96.85 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 43202 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 43202 covers
A flexible scope is passed through the mouth to inspect the esophagus, and tissue is collected for examination, typically with biopsy forceps. Gastroenterologists and other physicians trained in endoscopy may perform it in an office or an endoscopy facility. Common reasons include sampling an abnormal esophageal area, such as inflamed or suspicious mucosa. The service includes one or multiple biopsies during the examination.
Choose this code when the procedure is limited to the esophagus; if the examination extends into the stomach or duodenum, select the applicable upper endoscopy code instead. Document the esophageal findings, biopsy location, and sampling performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
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 Sacramento, CA compares for 43202
Across 109 of 109 payment localities, the office rate for 43202 runs from $343.20 in Arkansas to $541.91 in San Benito County, CA. Sacramento, CA pays $445.68. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Sacramento, CA · this page$445.68
- Bakersfield, CA · California$423.13−$22.55
- Chico, CA · California$422.51−$23.17
- El Centro, CA · California$422.54−$23.14
- Fresno, CA · California$422.51−$23.17
- Hanford, CA · California$422.51−$23.17
- Los Angeles, CA · California$453.46+$7.78
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $422.51 | $93.77 |
| Merced, CACalifornia | $422.51 | $93.77 |
| Modesto, CACalifornia | $422.51 | $93.77 |
| Napa, CACalifornia | $498.15 | $102.83 |
| Oxnard, CACalifornia | $452.12 | $97.59 |
| Redding, CACalifornia | $422.51 | $93.77 |
| Rest of CaliforniaCalifornia | $422.51 | $93.77 |
| Riverside, CACalifornia | $424.79 | $96.05 |
| Salinas, CACalifornia | $444.08 | $96.45 |
| San Diego, CACalifornia | $456.28 | $97.55 |
| Marin County, CACalifornia | $529.97 | $107.05 |
| San Francisco, CACalifornia | $529.73 | $106.81 |
| San Benito County, CACalifornia | $541.91 | $109.39 |
| Santa Clara County, CACalifornia | $540.93 | $108.42 |
| San Luis Obispo, CACalifornia | $436.70 | $95.07 |
| Santa Cruz, CACalifornia | $462.00 | $97.58 |
| Santa Maria, CACalifornia | $446.23 | $96.50 |
| Santa Rosa, CACalifornia | $466.80 | $98.47 |
| Stockton, CACalifornia | $422.51 | $93.77 |
| Vallejo, CACalifornia | $497.81 | $102.49 |
| Visalia, CACalifornia | $422.51 | $93.77 |
| Yuba City, CACalifornia | $422.51 | $93.77 |
| Washington, DC areaDistrict of Columbia | $455.69 | $102.36 |
| Miami, FLFlorida | $417.38 | $105.15 |
| Chicago, ILIllinois | $404.25 | $102.81 |
| Manhattan, NYNew York | $454.29 | $105.76 |
| AlaskaAlaska | $439.49 | $120.05 |
| AlabamaAlabama | $348.83 | $86.39 |
| ArkansasArkansas | $343.20 | $85.55 |
| ArizonaArizona | $381.89 | $91.25 |
| ColoradoColorado | $413.39 | $94.25 |
| ConnecticutConnecticut | $421.13 | $98.10 |
| DelawareDelaware | $388.74 | $92.40 |
| Fort Lauderdale, FLFlorida | $403.09 | $99.25 |
| Rest of FloridaFlorida | $382.14 | $95.39 |
| Atlanta, GAGeorgia | $399.99 | $95.25 |
| Rest of GeorgiaGeorgia | $358.84 | $91.29 |
| Hawaii, Guam, HIHawaii | $435.39 | $94.35 |
| IowaIowa | $360.85 | $86.40 |
| IdahoIdaho | $363.03 | $87.09 |
| East St. Louis, ILIllinois | $373.84 | $97.90 |
| Rest of IllinoisIllinois | $368.37 | $94.52 |
| Suburban Chicago, ILIllinois | $407.85 | $99.81 |
| IndianaIndiana | $365.43 | $87.39 |
| KansasKansas | $357.97 | $86.82 |
| KentuckyKentucky | $355.90 | $89.26 |
| New Orleans, LALouisiana | $374.61 | $92.37 |
| Rest of LouisianaLouisiana | $354.88 | $89.44 |
| Metropolitan Boston, MAMassachusetts | $458.68 | $100.55 |
| Rest of MassachusettsMassachusetts | $410.09 | $94.26 |
| Baltimore area, MDMaryland | $419.78 | $97.94 |
| Rest of MarylandMaryland | $397.07 | $93.54 |
| Rest of MaineMaine | $364.08 | $88.13 |
| Southern Maine, MEMaine | $387.57 | $90.33 |
| Detroit, MIMichigan | $386.39 | $96.95 |
| Rest of MichiganMichigan | $365.32 | $91.48 |
| MinnesotaMinnesota | $397.76 | $89.12 |
| Metropolitan Kansas City, MOMissouri | $372.84 | $91.19 |
| Metropolitan St. Louis, MOMissouri | $377.30 | $91.76 |
| Rest of MissouriMissouri | $347.41 | $88.86 |
| MississippiMississippi | $345.43 | $87.18 |
| MontanaMontana | $393.11 | $93.17 |
| North CarolinaNorth Carolina | $368.49 | $88.64 |
| North DakotaNorth Dakota | $388.96 | $89.02 |
| NebraskaNebraska | $363.36 | $86.51 |
| New HampshireNew Hampshire | $405.78 | $93.54 |
| Northern New JerseyNew Jersey | $449.94 | $102.01 |
| Rest of New JerseyNew Jersey | $426.41 | $98.88 |
| New MexicoNew Mexico | $367.15 | $92.10 |
| NevadaNevada | $392.29 | $92.05 |
| NYC suburbs and Long Island, NYNew York | $465.10 | $108.47 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $428.48 | $100.04 |
| Queens, NYNew York | $459.88 | $105.35 |
| Rest of New YorkNew York | $374.55 | $89.60 |
| OhioOhio | $364.47 | $90.63 |
| OklahomaOklahoma | $356.25 | $88.41 |
| Portland, OROregon | $428.86 | $95.63 |
| Rest of OregonOregon | $389.73 | $90.99 |
| Metropolitan Philadelphia, PAPennsylvania | $409.02 | $96.78 |
| Rest of PennsylvaniaPennsylvania | $365.68 | $90.34 |
| Puerto RicoPuerto Rico | $396.65 | $93.41 |
| Rhode IslandRhode Island | $404.33 | $94.49 |
| South CarolinaSouth Carolina | $367.00 | $89.85 |
| South DakotaSouth Dakota | $388.47 | $88.53 |
| TennesseeTennessee | $359.85 | $87.21 |
| Austin, TXTexas | $411.58 | $94.24 |
| Beaumont, TXTexas | $362.93 | $89.99 |
| Brazoria, TXTexas | $389.06 | $91.82 |
| Dallas, TXTexas | $391.32 | $92.58 |
| Fort Worth, TXTexas | $388.11 | $92.37 |
| Galveston, TXTexas | $390.06 | $92.22 |
| Houston, TXTexas | $393.90 | $96.06 |
| Rest of TexasTexas | $375.62 | $90.98 |
| UtahUtah | $372.61 | $90.67 |
| VirginiaVirginia | $385.46 | $90.62 |
| Virgin Islands, VIUnited States Virgin Islands | $396.65 | $93.41 |
| VermontVermont | $386.36 | $89.42 |
| Rest of WashingtonWashington | $409.67 | $93.83 |
| King County, WAWashington | $469.56 | $101.53 |
| WisconsinWisconsin | $374.41 | $87.07 |
| West VirginiaWest Virginia | $352.92 | $92.27 |
| WyomingWyoming | $391.30 | $91.36 |
43202 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$343.20
$482.21
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $439.49 | 1 |
| AL | $348.83 | 1 |
| AR | $343.20 | 1 |
| AZ | $381.89 | 1 |
| CA | $422.51–$541.91 | 29 |
| CO | $413.39 | 1 |
| CT | $421.13 | 1 |
| DC | $455.69 | 1 |
| DE | $388.74 | 1 |
| FL | $382.14–$417.38 | 3 |
| GA | $358.84–$399.99 | 2 |
| GU | $435.39 | 1 |
| HI | $435.39 | 1 |
| IA | $360.85 | 1 |
| ID | $363.03 | 1 |
| IL | $368.37–$407.85 | 4 |
| IN | $365.43 | 1 |
| KS | $357.97 | 1 |
| KY | $355.90 | 1 |
| LA | $354.88–$374.61 | 2 |
| MA | $410.09–$458.68 | 2 |
| MD | $397.07–$455.69 | 3 |
| ME | $364.08–$387.57 | 2 |
| MI | $365.32–$386.39 | 2 |
| MN | $397.76 | 1 |
| MO | $347.41–$377.30 | 3 |
| MS | $345.43 | 1 |
| MT | $393.11 | 1 |
| NC | $368.49 | 1 |
| ND | $388.96 | 1 |
| NE | $363.36 | 1 |
| NH | $405.78 | 1 |
| NJ | $426.41–$449.94 | 2 |
| NM | $367.15 | 1 |
| NV | $392.29 | 1 |
| NY | $374.55–$465.10 | 5 |
| OH | $364.47 | 1 |
| OK | $356.25 | 1 |
| OR | $389.73–$428.86 | 2 |
| PA | $365.68–$409.02 | 2 |
| PR | $396.65 | 1 |
| RI | $404.33 | 1 |
| SC | $367.00 | 1 |
| SD | $388.47 | 1 |
| TN | $359.85 | 1 |
| TX | $362.93–$411.58 | 8 |
| UT | $372.61 | 1 |
| VA | $385.46–$455.69 | 2 |
| VI | $396.65 | 1 |
| VT | $386.36 | 1 |
| WA | $409.67–$469.56 | 2 |
| WI | $374.41 | 1 |
| WV | $352.92 | 1 |
| WY | $391.30 | 1 |
How the 43202 rate is calculated
Each of 43202’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 · 43202
RVUs × geographic indexes × conversion factor
Work1.68
1.68 RVUs× 1.000 GPCI
Practice expense9.88
9.88 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
11.7700
Conversion factor
$33.4009
Medicare rate
$393.13
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Sacramento, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,142
- Code
- 43202
- Physician work
- 1.68
- Practice expense
- 9.88
- Malpractice
- 0.21
GPCI2026.csv
21
- Locality
- Sacramento, CA
- Physician work
- 1.036
- Practice expense
- 1.163
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.68 | × 1.036 | 1.7405 |
| Practice expense | 9.88 | × 1.163 | 11.4904 |
| Malpractice | 0.21 | × 0.536 | 0.1126 |
| Total RVUs | 13.3435 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Sacramento, CA$445.68
Office: (1.68 × 1.036 + 9.88 × 1.163 + 0.21 × 0.536) × $33.4009 = $445.68
Facility: (1.68 × 1.036 + 0.9 × 1.163 + 0.21 × 0.536) × $33.4009 = $96.85
Payment rules and modifiers for 43202
The CMS indicators that decide how 43202 is paid alongside other services.
CMS payment indicators · 43202
Esophageal biopsy, flexible transoral scope
| 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 | 3 | Endoscopy family rules apply. |
| 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
43202 without 51 · national office
$393.13
Esophageal biopsy, flexible transoral scope
43202-51 · Second procedure: 50%
$196.57
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%).
How 43202 has changed in Sacramento, CA
43202 · Office / nonfacility
$445.68
Effective 2026-10-01
The base rate is $67.83 higher than on 2025-10-01, moving from $377.85 to $445.68 (18.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$377.85changed to$445.68
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.72 changed to 1.68
- Practice expense RVU 8.46 changed to 9.88
- Malpractice RVU 0.22 changed to 0.21
- Work GPCI 1.034 changed to 1.036
- Practice expense GPCI 1.156 changed to 1.163
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$398.65changed to$377.85
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 8.71 changed to 8.46
- Malpractice RVU 0.23 changed to 0.22
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$392.15changed to$398.65
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$399.73changed to$392.15
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 8.83 changed to 8.71
- Work GPCI 1.036 changed to 1.034
- Practice expense GPCI 1.119 changed to 1.156
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$407.71changed to$399.73
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 9.12 changed to 8.83
- Work GPCI 1.038 changed to 1.036
- Practice expense GPCI 1.081 changed to 1.119
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$403.35changed to$407.71
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 8.94 changed to 9.12
- Malpractice RVU 0.22 changed to 0.23
- Work GPCI 1.036 changed to 1.038
- Practice expense GPCI 1.079 changed to 1.081
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$368.11changed to$403.35
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 7.69 changed to 8.94
- Malpractice RVU 0.23 changed to 0.22
- Work GPCI 1.033 changed to 1.036
- Practice expense GPCI 1.078 changed to 1.079
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$351.68changed to$368.11
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 7.19 changed to 7.69
- Malpractice RVU 0.25 changed to 0.23
- Work GPCI 1.027 changed to 1.033
- Practice expense GPCI 1.092 changed to 1.078
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$333.40changed to$351.68
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 6.77 changed to 7.19
- Malpractice RVU 0.26 changed to 0.25
- Work GPCI 1.025 changed to 1.027
- Practice expense GPCI 1.086 changed to 1.092
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$330.14changed to$333.40
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 6.74 changed to 6.77
- Work GPCI 1.024 changed to 1.025
- Practice expense GPCI 1.080 changed to 1.086
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$330.14
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $445.68 | $96.85 | RVU26D |
| 2026-07-01 | $445.68 | $96.85 | RVU26C |
| 2026-04-01 | $445.68 | $96.85 | RVU26B |
| 2026-01-01 | $445.68 | $96.85 | RVU26A |
| 2025-10-01 | $377.85 | $103.39 | RVU25D |
| 2025-07-01 | $377.85 | $103.39 | RVU25C |
| 2025-04-01 | $377.85 | $103.39 | RVU25B |
| 2025-01-01 | $377.85 | $103.39 | RVU25A |
| 2024-10-01 | $398.65 | $106.20 | RVU24D |
| 2024-07-01 | $398.65 | $106.20 | RVU24C |
| 2024-04-01 | $398.65 | $106.20 | RVU24B |
| 2024-03-09 | $398.65 | $106.20 | RVU24AR |
| 2024-01-01 | $392.15 | $104.47 | RVU24A |
| 2023-10-01 | $399.73 | $105.85 | RVU23D |
| 2023-07-01 | $399.73 | $105.85 | RVU23C |
| 2023-04-01 | $399.73 | $105.85 | RVU23B |
| 2023-01-01 | $399.73 | $105.85 | RVU23A |
| 2022-10-01 | $407.71 | $106.56 | RVU22D |
| 2022-07-01 | $407.71 | $106.56 | RVU22C |
| 2022-04-01 | $407.71 | $106.56 | RVU22B |
| 2022-01-01 | $407.71 | $106.56 | RVU22A |
| 2021-10-01 | $403.35 | $106.29 | RVU21D |
| 2021-07-01 | $403.35 | $106.29 | RVU21C |
| 2021-04-01 | $403.35 | $106.29 | RVU21B |
| 2021-01-01 | $403.35 | $106.29 | RVU21A |
| 2020-10-01 | $368.11 | $108.62 | RVU20D |
| 2020-07-01 | $368.11 | $108.62 | RVU20C |
| 2020-04-01 | $368.11 | $108.62 | RVU20B |
| 2020-01-01 | $368.11 | $108.62 | RVU20A |
| 2019-10-01 | $351.68 | $109.26 | RVU19D |
| 2019-07-01 | $351.68 | $109.26 | RVU19C |
| 2019-04-01 | $351.68 | $109.26 | RVU19B |
| 2019-01-01 | $351.68 | $109.26 | RVU19A |
| 2018-10-01 | $333.40 | $109.39 | RVU18D |
| 2018-07-01 | $333.40 | $109.39 | RVU18C |
| 2018-04-01 | $333.40 | $109.39 | RVU18B |
| 2018-01-01 | $333.40 | $109.39 | RVU18AR1 |
| 2017-10-01 | $330.14 | $109.60 | RVU17D |
| 2017-07-01 | $330.14 | $109.60 | RVU17C |
| 2017-04-01 | $330.14 | $109.60 | RVU17B |
| 2017-01-01 | $330.14 | $109.60 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Sacramento, CA rate applies
Sacramento, CA is a Medicare payment area, not a city. Our Census mapping connects it to 89 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Folsom
- Roseville
- Sacramento
- Alta
- Antelope
- Arden-Arcade
- Auburn
- Auburn Lake Trails
43202 billing questions
How is this different from code 43200?
Code 43202 involves tissue biopsy, generally collected with forceps. Code 43200 describes esophageal brushing for cytology rather than forceps tissue sampling.
Can a separate biopsy code be reported for the same esophageal samples?
The biopsy is included in this service. Do not separately report another biopsy service for the same sampling.
When should an EGD code be selected instead?
Use an applicable EGD code when the examination includes the stomach or duodenum. This code is for examination and biopsy confined to the esophagus.
How does CMS price related endoscopies performed in the same session?
CMS applies endoscopy-family pricing when related endoscopies are performed together. The 0-day global period includes same-day preoperative and postoperative care.
Which surgical modifiers are appropriate?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
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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