CPT code 43206: Esophagoscopy, optical endomicroscopy2026 Medicare rate & RVUs in Illinois
Report flexible transoral esophagoscopy with optical endomicroscopy when microscopic imaging is used to assess esophageal mucosa during the endoscopic examination.
Medicare pays $322.43–$354.03 for 43206 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. 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 43206 covers
A gastroenterologist or other qualified endoscopist uses a flexible scope passed through the mouth to examine the esophagus and obtain microscopic images of its lining in real time. The added imaging can help characterize abnormal mucosa, including areas evaluated during assessment of Barrett’s esophagus. It provides an optical view of tissue architecture rather than a specimen for conventional histologic examination.
Choose this service when the procedure record documents optical endomicroscopy during flexible transoral esophagoscopy, including the examined area and imaging findings. A tissue biopsy or brush sampling is a different service; when related endoscopies are performed together, CMS endoscopy-family pricing applies. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate for this single esophageal service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery 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.
Where 43206 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$322.43 to $354.03
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $352.55 | $129.66 |
| East St. Louis, IL | $327.86 | $123.82 |
| Rest of Illinois | $322.43 | $119.95 |
| Suburban Chicago, IL | $354.03 | $126.26 |
How the 43206 rate is calculated
Each of 43206’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 · 43206
RVUs × geographic indexes × conversion factor
Work2.23
2.23 RVUs× 1.000 GPCI
Practice expense7.72
7.72 RVUs× 1.000 GPCI
Malpractice0.24
0.24 RVUs× 1.000 GPCI
Adjusted RVUs
10.1900
Conversion factor
$33.4009
Medicare rate
$340.36
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43206
The CMS indicators that decide how 43206 is paid alongside other services.
CMS payment indicators · 43206
Esophagoscopy, optical endomicroscopy
| 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
43206 without 51 · national office
$340.36
Esophagoscopy, optical endomicroscopy
43206-51 · Second procedure: 50%
$170.18
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%).
43206 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43202Esophageal biopsyFlexible transoral scope
- Choose 43206 for optical microscopic imaging during esophagoscopy. Choose 43202 when tissue is sampled for histologic examination.
- 43231Esophageal EUSExamination only, esophagus
- Code 43231 describes esophageal endoscopic ultrasound examination; 43206 describes optical endomicroscopic imaging of the esophageal lining.
- 43235Upper GI endoscopyDiagnostic, brushings or washings
- Code 43235 is an EGD service involving examination beyond the esophagus, with brush or wash sampling. Code 43206 is limited to esophagoscopy with optical endomicroscopy.
43206 billing questions
How does this differ from esophageal biopsy code 43202?
Code 43206 captures optical microscopic imaging of the esophageal lining; 43202 captures tissue sampling for histologic examination. Document the imaging and any biopsy separately when both are performed.
Is this an EGD that includes the stomach and duodenum?
No. This service is flexible transoral esophagoscopy with optical endomicroscopy. An EGD code describes examination extending beyond the esophagus.
Should modifier 50 be appended?
No. The esophageal service is not bilateral work, and modifier 50 is inappropriate.
What documentation supports reporting 43206?
Record the flexible transoral esophagoscopy, use of optical endomicroscopy, the esophageal area assessed, and the imaging findings.
How is it handled when another related endoscopy is performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The record should identify each procedure actually performed.
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
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