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CPT code 43202: Esophageal biopsy, flexible transoral scope2026 Medicare rate & RVUs in Connecticut

Flexible esophagoscopy with forceps sampling of esophageal tissue is reported when examination is confined to the esophagus and tissue diagnosis is needed.

CMS RVU26DEffective Oct 1, 2026One payment locality2.4K Medicare services in 2024

In Connecticut, Medicare pays $421.13 for 43202 in the office and $98.10 when it’s performed in a hospital or facility.

$421.13Office (non-facility)
$98.10Hospital or facility
+7.1%vs the national office rate ($393.13)

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.

We’ll open 43202 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 43202 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 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 Connecticut 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. Connecticut pays $421.13. The RVUs are the same everywhere; the geographic indexes change the dollars.

43202 in Connecticut vs other payment areas
  1. Connecticut · this page$421.13
  2. Los Angeles, CA · California$453.46+$32.33
  3. Washington, DC area · District of Columbia$455.69+$34.56
  4. Miami, FL · Florida$417.38−$3.75
  5. Chicago, IL · Illinois$404.25−$16.88
  6. Manhattan, NY · New York$454.29+$33.16
  7. Alaska · Alaska$439.49+$18.36

Other areas in Connecticut first, then benchmark localities. Bars start at $0.

Every other payment area

43202 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$348.83$86.39
ArkansasArkansas$343.20$85.55
ArizonaArizona$381.89$91.25
Bakersfield, CACalifornia$423.13$94.40
Chico, CACalifornia$422.51$93.77
El Centro, CACalifornia$422.54$93.81
Fresno, CACalifornia$422.51$93.77
Hanford, CACalifornia$422.51$93.77

43202 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.

$343.20

$482.21

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

View every state and territory as a table
43202 office rate range by state
State / territoryOffice rate rangeLocalities
AK$439.491
AL$348.831
AR$343.201
AZ$381.891
CA$422.51–$541.9129
CO$413.391
CT$421.131
DC$455.691
DE$388.741
FL$382.14–$417.383
GA$358.84–$399.992
GU$435.391
HI$435.391
IA$360.851
ID$363.031
IL$368.37–$407.854
IN$365.431
KS$357.971
KY$355.901
LA$354.88–$374.612
MA$410.09–$458.682
MD$397.07–$455.693
ME$364.08–$387.572
MI$365.32–$386.392
MN$397.761
MO$347.41–$377.303
MS$345.431
MT$393.111
NC$368.491
ND$388.961
NE$363.361
NH$405.781
NJ$426.41–$449.942
NM$367.151
NV$392.291
NY$374.55–$465.105
OH$364.471
OK$356.251
OR$389.73–$428.862
PA$365.68–$409.022
PR$396.651
RI$404.331
SC$367.001
SD$388.471
TN$359.851
TX$362.93–$411.588
UT$372.611
VA$385.46–$455.692
VI$396.651
VT$386.361
WA$409.67–$469.562
WI$374.411
WV$352.921
WY$391.301

See 43202 in every payment locality

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

Office or facility?

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 Connecticut 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

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 43202 in Connecticut
ComponentRVULocality factorAdjusted
Physician work1.68× 1.0201.7136
Practice expense9.88× 1.07710.6408
Malpractice0.21× 1.2100.2541
Total RVUs12.6085
Conversion factor× 33.4009

Office rate, Connecticut$421.13

Office: (1.68 × 1.02 + 9.88 × 1.077 + 0.21 × 1.21) × $33.4009 = $421.13

Facility: (1.68 × 1.02 + 0.9 × 1.077 + 0.21 × 1.21) × $33.4009 = $98.10

Open 43202 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
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

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%).

When to use modifier 51

Codes related to 43202

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

Codes related to 43202
CodeHow it relatesOffice range, Connecticut
Used instead
43200Esophagoscopy, flexible scope with brushingsEsophageal brushing provides cytology sampling rather than forceps tissue biopsy.$307.31
43232Esophageal EUS, EUS-guided needle samplingUses ultrasound-guided needle sampling of an esophageal target rather than routine mucosal forceps biopsy.No office rate
43235Upper GI endoscopy, diagnostic, brushings or washingsUpper endoscopy is used when the examination extends beyond the esophagus; it is not this esophageal biopsy service.$344.68

How 43202 has changed in Connecticut

43202 · Office / nonfacility

$421.13

Effective 2026-10-01

The base rate is $57.13 higher than on 2025-10-01, moving from $364.00 to $421.13 (15.7%).

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

    $364.00changed to$421.13

    • 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 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $384.07changed to$364.00

    • 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.

  3. March 9, 2024

    RVU24AR

    $377.80changed to$384.07

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $398.12changed to$377.80

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.83 changed to 8.71
    • Work GPCI 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $420.75changed to$398.12

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.12 changed to 8.83
    • Work GPCI 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $416.91changed to$420.75

    • 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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $381.84changed to$416.91

    • 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 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $362.74changed to$381.84

    • 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 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $345.98changed to$362.74

    • 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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $344.95changed to$345.98

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.74 changed to 6.77
    • Work GPCI 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $408.56changed to$344.95

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 1.82 changed to 1.72
    • Practice expense RVU 8.22 changed to 6.74
    • Malpractice RVU 0.27 changed to 0.26
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $413.74changed to$408.56

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.29 changed to 8.22
    • Malpractice RVU 0.29 changed to 0.27

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $411.68changed to$413.74

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $405.79changed to$411.68

    • Conversion factor 35.8228 changed to 35.7547
    • Work RVU 1.80 changed to 1.82
    • Practice expense RVU 8.20 changed to 8.29
    • Malpractice RVU 0.27 changed to 0.29
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $330.31changed to$405.79

    • Conversion factor 34.0230 changed to 35.8228
    • Work RVU 1.89 changed to 1.80
    • Practice expense RVU 6.68 changed to 8.20
    • Malpractice RVU 0.29 changed to 0.27
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $330.31

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$421.13$98.10RVU26D
2026-07-01$421.13$98.10RVU26C
2026-04-01$421.13$98.10RVU26B
2026-01-01$421.13$98.10RVU26A
2025-10-01$364.00$104.97RVU25D
2025-07-01$364.00$104.97RVU25C
2025-04-01$364.00$104.97RVU25B
2025-01-01$364.00$104.97RVU25A
2024-10-01$384.07$108.07RVU24D
2024-07-01$384.07$108.07RVU24C
2024-04-01$384.07$108.07RVU24B
2024-03-09$384.07$108.07RVU24AR
2024-01-01$377.80$106.30RVU24A
2023-10-01$398.12$108.71RVU23D
2023-07-01$398.12$108.71RVU23C
2023-04-01$398.12$108.71RVU23B
2023-01-01$398.12$108.71RVU23A
2022-10-01$420.75$110.41RVU22D
2022-07-01$420.75$110.41RVU22C
2022-04-01$420.75$110.41RVU22B
2022-01-01$420.75$110.41RVU22A
2021-10-01$416.91$110.22RVU21D
2021-07-01$416.91$110.22RVU21C
2021-04-01$416.91$110.22RVU21B
2021-01-01$416.91$110.22RVU21A
2020-10-01$381.84$113.93RVU20D
2020-07-01$381.84$113.93RVU20C
2020-04-01$381.84$113.93RVU20B
2020-01-01$381.84$113.93RVU20A
2019-10-01$362.74$115.87RVU19D
2019-07-01$362.74$115.87RVU19C
2019-04-01$362.74$115.87RVU19B
2019-01-01$362.74$115.87RVU19A
2018-10-01$345.98$116.60RVU18D
2018-07-01$345.98$116.60RVU18C
2018-04-01$345.98$116.60RVU18B
2018-01-01$345.98$116.60RVU18AR1
2017-10-01$344.95$116.85RVU17D
2017-07-01$344.95$116.85RVU17C
2017-04-01$344.95$116.85RVU17B
2017-01-01$344.95$116.85RVU17A
2016-10-01$408.56$122.39RVU16D
2016-07-01$408.56$122.39RVU16C
2016-04-01$408.56$122.39RVU16B
2016-01-01$408.56$122.39RVU16A
2015-10-01$413.74$124.92RVU15D
2015-07-01$413.74$124.92RVU15C
2015-04-01$411.68$124.30RVU15B
2015-01-01$411.68$124.30RVU15A
2014-10-01$405.79$122.74RVU14D
2014-07-01$405.79$122.74RVU14C
2014-04-01$405.79$122.74RVU14B
2014-01-01$405.79$122.74RVU14A
2013-10-01$330.31$126.75RVU13D
2013-07-01$330.31$126.75RVU13C
2013-04-01$330.31$126.75RVU13B
2013-01-01$330.31$126.75RVU13AR

Price 43202 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

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
RVUs for 43202PPRRVU2026_Oct_nonQPP.csv, line 5,142 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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