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

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 Rhode Island, Medicare pays $404.33 for 43202 in the office and $94.49 when it’s performed in a hospital or facility.

$404.33Office (non-facility)
$94.49Hospital or facility
+2.8%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 Rhode Island
  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 Rhode Island 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. Rhode Island pays $404.33. The RVUs are the same everywhere; the geographic indexes change the dollars.

43202 in Rhode Island vs other payment areas
  1. Rhode Island · this page$404.33
  2. Los Angeles, CA · California$453.46+$49.13
  3. Washington, DC area · District of Columbia$455.69+$51.36
  4. Miami, FL · Florida$417.38+$13.05
  5. Chicago, IL · Illinois$404.25−$0.08
  6. Manhattan, NY · New York$454.29+$49.96
  7. Alaska · Alaska$439.49+$35.16

Other areas in Rhode Island 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 Rhode Island 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

92

Locality
Rhode Island
Physician work
1.019
Practice expense
1.033
Malpractice
0.892
Office calculation for 43202 in Rhode Island
ComponentRVULocality factorAdjusted
Physician work1.68× 1.0191.7119
Practice expense9.88× 1.03310.2060
Malpractice0.21× 0.8920.1873
Total RVUs12.1053
Conversion factor× 33.4009

Office rate, Rhode Island$404.33

Office: (1.68 × 1.019 + 9.88 × 1.033 + 0.21 × 0.892) × $33.4009 = $404.33

Facility: (1.68 × 1.019 + 0.9 × 1.033 + 0.21 × 0.892) × $33.4009 = $94.49

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, Rhode Island
Used instead
43200Esophagoscopy, flexible scope with brushingsEsophageal brushing provides cytology sampling rather than forceps tissue biopsy.$294.75
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.$331.22

How 43202 has changed in Rhode Island

43202 · Office / nonfacility

$404.33

Effective 2026-10-01

The base rate is $56.94 higher than on 2025-10-01, moving from $347.39 to $404.33 (16.4%).

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

    $347.39changed to$404.33

    • 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 1.025 changed to 1.019
    • Practice expense GPCI 1.039 changed to 1.033
    • Malpractice GPCI 0.849 changed to 0.892

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $366.43changed to$347.39

    • 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

    $360.45changed to$366.43

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $379.15changed to$360.45

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.83 changed to 8.71
    • Work GPCI 1.023 changed to 1.025
    • Practice expense GPCI 1.044 changed to 1.039
    • Malpractice GPCI 0.915 changed to 0.849

  5. January 1, 2023

    RVU23A

    $399.34changed to$379.15

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.12 changed to 8.83
    • Work GPCI 1.021 changed to 1.023
    • Practice expense GPCI 1.048 changed to 1.044
    • Malpractice GPCI 0.981 changed to 0.915

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $395.72changed to$399.34

    • 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

    $362.91changed to$395.72

    • 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 1.024 changed to 1.021
    • Practice expense GPCI 1.049 changed to 1.048
    • Malpractice GPCI 0.990 changed to 0.981

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $344.74changed to$362.91

    • 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 1.024
    • Practice expense GPCI 1.050 changed to 1.049
    • Malpractice GPCI 0.999 changed to 0.990

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $328.84changed to$344.74

    • 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

    $325.94changed to$328.84

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.74 changed to 6.77
    • Work GPCI 1.025 changed to 1.027
    • Practice expense GPCI 1.052 changed to 1.050
    • Malpractice GPCI 0.879 changed to 0.999

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $383.84changed to$325.94

    • 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 1.022 changed to 1.025
    • Practice expense GPCI 1.053 changed to 1.052
    • Malpractice GPCI 0.759 changed to 0.879

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $388.42changed to$383.84

    • 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

    $386.49changed to$388.42

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $384.50changed to$386.49

    • 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
    • Work GPCI 1.020 changed to 1.022
    • Malpractice GPCI 0.973 changed to 0.759

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$384.50

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$404.33$94.49RVU26D
2026-07-01$404.33$94.49RVU26C
2026-04-01$404.33$94.49RVU26B
2026-01-01$404.33$94.49RVU26A
2025-10-01$347.39$100.71RVU25D
2025-07-01$347.39$100.71RVU25C
2025-04-01$347.39$100.71RVU25B
2025-01-01$347.39$100.71RVU25A
2024-10-01$366.43$103.58RVU24D
2024-07-01$366.43$103.58RVU24C
2024-04-01$366.43$103.58RVU24B
2024-03-09$366.43$103.58RVU24AR
2024-01-01$360.45$101.89RVU24A
2023-10-01$379.15$104.97RVU23D
2023-07-01$379.15$104.97RVU23C
2023-04-01$379.15$104.97RVU23B
2023-01-01$379.15$104.97RVU23A
2022-10-01$399.34$107.39RVU22D
2022-07-01$399.34$107.39RVU22C
2022-04-01$399.34$107.39RVU22B
2022-01-01$399.34$107.39RVU22A
2021-10-01$395.72$107.20RVU21D
2021-07-01$395.72$107.20RVU21C
2021-04-01$395.72$107.20RVU21B
2021-01-01$395.72$107.20RVU21A
2020-10-01$362.91$110.40RVU20D
2020-07-01$362.91$110.40RVU20C
2020-04-01$362.91$110.40RVU20B
2020-01-01$362.91$110.40RVU20A
2019-10-01$344.74$111.64RVU19D
2019-07-01$344.74$111.64RVU19C
2019-04-01$344.74$111.64RVU19B
2019-01-01$344.74$111.64RVU19A
2018-10-01$328.84$112.25RVU18D
2018-07-01$328.84$112.25RVU18C
2018-04-01$328.84$112.25RVU18B
2018-01-01$328.84$112.25RVU18AR1
2017-10-01$325.94$111.12RVU17D
2017-07-01$325.94$111.12RVU17C
2017-04-01$325.94$111.12RVU17B
2017-01-01$325.94$111.12RVU17A
2016-10-01$383.84$115.03RVU16D
2016-07-01$383.84$115.03RVU16C
2016-04-01$383.84$115.03RVU16B
2016-01-01$383.84$115.03RVU16A
2015-10-01$388.42$117.13RVU15D
2015-07-01$388.42$117.13RVU15C
2015-04-01$386.49$116.54RVU15B
2015-01-01$386.49$116.54RVU15A
2014-10-01$384.50$117.43RVU14D
2014-07-01$384.50$117.43RVU14C
2014-04-01$384.50$117.43RVU14B
2014-01-01$384.50$117.43RVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 43202 for an earlier date of service

Where the Rhode Island rate applies

Rhode Island is a Medicare payment area, not a city. Our Census mapping connects it to 36 cities and communities in Rhode Island. Some span more than one payment area; confirm with the service ZIP.

  • Ashaway
  • Bradford
  • Carolina
  • Central Falls
  • Charlestown
  • Chepachet
  • Clayville
  • Cranston

Browse all communities in Rhode Island

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 Rhode IslandGPCI2026.csv, line 92 (RVU26D)

Open CMS sourceHow we calculate rates

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