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CPT code 43206: Esophagoscopy, optical endomicroscopy2026 Medicare rate & RVUs in Vermont

Report flexible transoral esophagoscopy with optical endomicroscopy when microscopic imaging is used to assess esophageal mucosa during the endoscopic examination.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Vermont, Medicare pays $333.82 for 43206 in the office and $114.25 when it’s performed in a hospital or facility.

$333.82Office (non-facility)
$114.25Hospital or facility
−1.9%vs the national office rate ($340.36)

Check a contract rate as a % of Medicare · 43206 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 43206 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Vermont
  2. What 43206 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 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.

How Vermont compares for 43206

Across 109 of 109 payment localities, the office rate for 43206 runs from $300.11 in Arkansas to $458.80 in San Benito County, CA. Vermont pays $333.82. The RVUs are the same everywhere; the geographic indexes change the dollars.

43206 in Vermont vs other payment areas
  1. Vermont · this page$333.82
  2. Los Angeles, CA · California$387.90+$54.08
  3. Washington, DC area · District of Columbia$391.18+$57.36
  4. Miami, FL · Florida$363.18+$29.36
  5. Chicago, IL · Illinois$352.55+$18.73
  6. Manhattan, NY · New York$391.59+$57.77
  7. Alaska · Alaska$390.76+$56.94

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

Every other payment area

43206 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$304.64$110.59
ArkansasArkansas$300.11$109.60
ArizonaArizona$331.21$116.30
Bakersfield, CACalifornia$363.39$120.32
Chico, CACalifornia$362.66$119.58
El Centro, CACalifornia$362.70$119.62
Fresno, CACalifornia$362.66$119.58
Hanford, CACalifornia$362.66$119.58

43206 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.

$300.11

$410.73

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

View every state and territory as a table
43206 office rate range by state
State / territoryOffice rate rangeLocalities
AK$390.761
AL$304.641
AR$300.111
AZ$331.211
CA$362.66–$458.8029
CO$356.001
CT$363.381
DC$391.181
DE$336.821
FL$333.04–$363.183
GA$314.05–$346.322
GU$372.311
HI$372.311
IA$313.601
ID$315.501
IL$322.43–$354.034
IN$317.411
KS$311.631
KY$311.051
LA$310.37–$326.232
MA$353.59–$392.552
MD$343.54–$391.183
ME$316.70–$335.082
MI$318.96–$336.832
MN$342.191
MO$304.56–$327.993
MS$302.421
MT$340.341
NC$320.191
ND$335.591
NE$315.511
NH$349.931
NJ$367.83–$386.852
NM$320.561
NV$339.271
NY$325.08–$400.735
OH$317.991
OK$310.981
OR$336.94–$368.122
PA$318.77–$353.822
PR$343.071
RI$349.411
SC$319.561
SD$335.031
TN$313.181
TX$316.58–$354.558
UT$324.071
VA$333.61–$391.182
VI$343.071
VT$333.821
WA$353.07–$401.152
WI$323.981
WV$310.031
WY$338.271

See 43206 in every payment locality

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

Office or facility?

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.

The exact Vermont inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,145

Code
43206
Physician work
2.23
Practice expense
7.72
Malpractice
0.24

GPCI2026.csv

105

Locality
Vermont
Physician work
1.000
Practice expense
0.990
Malpractice
0.506
Office calculation for 43206 in Vermont
ComponentRVULocality factorAdjusted
Physician work2.23× 1.0002.2300
Practice expense7.72× 0.9907.6428
Malpractice0.24× 0.5060.1214
Total RVUs9.9942
Conversion factor× 33.4009

Office rate, Vermont$333.82

Office: (2.23 × 1 + 7.72 × 0.99 + 0.24 × 0.506) × $33.4009 = $333.82

Facility: (2.23 × 1 + 1.08 × 0.99 + 0.24 × 0.506) × $33.4009 = $114.25

Open 43206 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 43206

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

Codes related to 43206
CodeHow it relatesOffice range, Vermont
Same family
43200Esophagoscopy, flexible scope with brushingsEsophagoscopy with brush sampling rather than optical microscopic imaging.$281.11
43202Esophageal biopsy, flexible transoral scopeEsophagoscopy with biopsy for tissue examination.$386.36
43231Esophageal EUS, examination only, esophagusEsophagoscopy with endoscopic ultrasound examination.No office rate
43235Upper GI endoscopy, diagnostic, brushings or washingsDiagnostic EGD with brush or wash sampling; examines a broader upper gastrointestinal tract.$316.23

How 43206 has changed in Vermont

43206 · Office / nonfacility

$333.82

Effective 2026-10-01

The base rate is $48.05 higher than on 2025-10-01, moving from $285.77 to $333.82 (16.8%).

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

    $285.77changed to$333.82

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.29 changed to 2.23
    • Practice expense RVU 6.45 changed to 7.72
    • Malpractice RVU 0.27 changed to 0.24
    • Practice expense GPCI 0.993 changed to 0.990
    • Malpractice GPCI 0.518 changed to 0.506

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $296.89changed to$285.77

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.54 changed to 6.45
    • Malpractice RVU 0.26 changed to 0.27

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $292.04changed to$296.89

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $303.34changed to$292.04

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense GPCI 0.997 changed to 0.993
    • Malpractice GPCI 0.543 changed to 0.518

  5. January 1, 2023

    RVU23A

    $316.26changed to$303.34

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.70 changed to 6.54
    • Malpractice RVU 0.25 changed to 0.26
    • Practice expense GPCI 1.001 changed to 0.997
    • Malpractice GPCI 0.569 changed to 0.543

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $312.60changed to$316.26

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.52 changed to 6.70

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $291.61changed to$312.60

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.60 changed to 6.52
    • Practice expense GPCI 1.008 changed to 1.001
    • Malpractice GPCI 0.582 changed to 0.569

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $281.37changed to$291.61

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.26 changed to 5.60
    • Malpractice RVU 0.30 changed to 0.25
    • Practice expense GPCI 1.015 changed to 1.008
    • Malpractice GPCI 0.595 changed to 0.582

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $272.08changed to$281.37

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.02 changed to 5.26
    • Malpractice RVU 0.29 changed to 0.30

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $269.22changed to$272.08

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.97 changed to 5.02
    • Malpractice RVU 0.30 changed to 0.29
    • Practice expense GPCI 1.010 changed to 1.015
    • Malpractice GPCI 0.639 changed to 0.595

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $333.64changed to$269.22

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.39 changed to 2.29
    • Practice expense RVU 6.67 changed to 4.97
    • Malpractice RVU 0.34 changed to 0.30
    • Practice expense GPCI 1.004 changed to 1.010
    • Malpractice GPCI 0.682 changed to 0.639

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $336.67changed to$333.64

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 6.70 changed to 6.67
    • Malpractice RVU 0.37 changed to 0.34

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $334.99changed to$336.67

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $334.01changed to$334.99

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.69 changed to 6.70
    • Malpractice RVU 0.33 changed to 0.37
    • Practice expense GPCI 1.006 changed to 1.004
    • Malpractice GPCI 0.618 changed to 0.682

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$334.01

    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$333.82$114.25RVU26D
2026-07-01$333.82$114.25RVU26C
2026-04-01$333.82$114.25RVU26B
2026-01-01$333.82$114.25RVU26A
2025-10-01$285.77$123.57RVU25D
2025-07-01$285.77$123.57RVU25C
2025-04-01$285.77$123.57RVU25B
2025-01-01$285.77$123.57RVU25A
2024-10-01$296.89$126.00RVU24D
2024-07-01$296.89$126.00RVU24C
2024-04-01$296.89$126.00RVU24B
2024-03-09$296.89$126.00RVU24AR
2024-01-01$292.04$123.94RVU24A
2023-10-01$303.34$128.00RVU23D
2023-07-01$303.34$128.00RVU23C
2023-04-01$303.34$128.00RVU23B
2023-01-01$303.34$128.00RVU23A
2022-10-01$316.26$130.94RVU22D
2022-07-01$316.26$130.94RVU22C
2022-04-01$316.26$130.94RVU22B
2022-01-01$316.26$130.94RVU22A
2021-10-01$312.60$131.32RVU21D
2021-07-01$312.60$131.32RVU21C
2021-04-01$312.60$131.32RVU21B
2021-01-01$312.60$131.32RVU21A
2020-10-01$291.61$134.82RVU20D
2020-07-01$291.61$134.82RVU20C
2020-04-01$291.61$134.82RVU20B
2020-01-01$291.61$134.82RVU20A
2019-10-01$281.37$136.88RVU19D
2019-07-01$281.37$136.88RVU19C
2019-04-01$281.37$136.88RVU19B
2019-01-01$281.37$136.88RVU19A
2018-10-01$272.08$137.25RVU18D
2018-07-01$272.08$137.25RVU18C
2018-04-01$272.08$137.25RVU18B
2018-01-01$272.08$137.25RVU18AR1
2017-10-01$269.22$137.27RVU17D
2017-07-01$269.22$137.27RVU17C
2017-04-01$269.22$137.27RVU17B
2017-01-01$269.22$137.27RVU17A
2016-10-01$333.64$143.48RVU16D
2016-07-01$333.64$143.48RVU16C
2016-04-01$333.64$143.48RVU16B
2016-01-01$333.64$143.48RVU16A
2015-10-01$336.67$143.65RVU15D
2015-07-01$336.67$143.65RVU15C
2015-04-01$334.99$142.94RVU15B
2015-01-01$334.99$142.94RVU15A
2014-10-01$334.01$144.46RVU14D
2014-07-01$334.01$144.46RVU14C
2014-04-01$334.01$144.46RVU14B
2014-01-01$334.01$144.46RVU14A
2013-10-01Contractor-pricedContractor-pricedRVU13D
2013-07-01Contractor-pricedContractor-pricedRVU13C
2013-04-01Contractor-pricedContractor-pricedRVU13B
2013-01-01Contractor-pricedContractor-pricedRVU13AR

Price 43206 for an earlier date of service

Where the Vermont rate applies

Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.

  • Albany
  • Alburgh
  • Algiers
  • Arlington
  • Ascutney
  • Bakersfield
  • Barnet
  • Barre

Browse all communities in Vermont

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

Show the CMS file lines behind this rate
RVUs for 43206PPRRVU2026_Oct_nonQPP.csv, line 5,145 (RVU26D)
Geographic factors for VermontGPCI2026.csv, line 105 (RVU26D)

Open CMS sourceHow we calculate rates

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