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CPT code 43231: Esophageal EUS, examination only, esophagus2026 Medicare rate & RVUs

Reports transoral flexible esophagoscopy with endoscopic ultrasound confined to the esophagus, such as assessment of an esophageal lesion or wall thickening.

CMS RVU26DEffective Oct 1, 2026109 payment localities541 Medicare services in 2024

Medicare pays $137.95 for 43231 nationally in a facility.

Medicare rate · 43231

Esophageal EUS, examination only, esophagus

Office or facility?

Work RVUs
2.73
Total RVUs
4.13
Global days
000

National rate · 2026

$137.95

Facility setting, before claim adjustments.

See every locality for 43231 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 43231 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43231 covers

A gastroenterologist or other qualified physician passes a flexible endoscope through the mouth and uses ultrasound to examine structures in or adjacent to the esophagus. Typical uses include assessing an esophageal subepithelial lesion, wall thickening, or local tumor involvement. The ultrasound examination must be confined to the esophagus; this is not the code for an EUS-guided needle sample.

Select this service based on the documented scope and extent of the ultrasound examination, not simply the patient’s diagnosis. The report should identify the esophageal findings and support that EUS was performed. When related endoscopies are performed together, CMS endoscopy family pricing adjusts payment for the combined services. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery; co-surgeons are permitted, while team surgery is not.

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 43231 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43231 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$129.31
AlaskaUnavailable$181.94
ArizonaUnavailable$135.48
ArkansasUnavailable$128.25
Atlanta, GAUnavailable$140.64
Austin, TXUnavailable$139.29
Bakersfield, CAUnavailable$139.78
Baltimore area, MDUnavailable$144.30
Beaumont, TXUnavailable$133.91
Brazoria, TXUnavailable$136.35

43231 rates by state

Office rate range in each state. Select a state to see its payment localities.

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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.

View every state and territory as a table
43231 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43231 rate is calculated

Each of 43231’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 · 43231

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.73

2.73 RVUs× 1.000 GPCI

Practice expense1.13

1.13 RVUs× 1.000 GPCI

Malpractice0.27

0.27 RVUs× 1.000 GPCI

Adjusted RVUs

4.1300

Conversion factor

$33.4009

Medicare rate

$137.95

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 43231

The CMS indicators that decide how 43231 is paid alongside other services.

CMS payment indicators · 43231

Esophageal EUS, examination only, esophagus

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)2Permitted.
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

43231 without 51 · national facility

$137.95

Esophageal EUS, examination only, esophagus

43231-51 · Second procedure: 50%

$68.98

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

43231 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43231

    Esophageal EUS, examination only, esophagus2.73 wRVU

    Not priced

  • 43232

    Esophageal EUS, EUS-guided needle sampling3.5 wRVU

    Not priced

  • 43237

    Endoscopic ultrasound, limited upper GI examination3.38 wRVU

    Not priced

  • 43238

    EUS-guided biopsy, limited upper GI examination4.06 wRVU

    Not priced

How to choose

43232Esophageal EUSEUS-guided needle sampling
Choose 43231 for esophageal EUS without needle sampling. Choose 43232 when the esophageal EUS includes transendoscopic fine needle aspiration or biopsy.
43237Endoscopic ultrasoundLimited upper GI examination
43231 is confined to esophagoscopy and esophageal EUS. 43237 describes an EGD-based EUS examination that may include the stomach or duodenum as appropriate.
43238EUS-guided biopsyLimited upper GI examination
43238 is an EGD-based EUS service with guided needle sampling; 43231 is an examination-only esophageal EUS service.

Codes related to 43231

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

Codes related to 43231
CodeHow it relatesNational office range
Same family
43232Esophageal EUS, EUS-guided needle samplingEsophageal EUS with needle sampling, rather than examination alone.No office rate
Used instead
43237Endoscopic ultrasound, limited upper GI examinationEGD-based EUS when the examination includes the stomach or duodenum as appropriate.No office rate
43238EUS-guided biopsy, limited upper GI examinationEGD-based EUS with guided needle sampling of upper gastrointestinal structures.No office rate

43231 billing questions

When should 43231 be chosen over 43237?

Use 43231 when flexible esophagoscopy with EUS is confined to the esophagus. Use 43237 for an EGD-based EUS examination that includes the stomach or duodenum as appropriate.

How does 43231 differ from 43232?

43231 describes an esophageal EUS examination without needle sampling. 43232 is for esophageal EUS-guided fine needle aspiration or biopsy.

Can EUS-guided needle sampling be reported with 43231?

When EUS-guided sampling is performed, consider the sampling code that matches the scope and anatomic extent, such as 43232 for esophageal esophagoscopy. The documentation should show the sampling service performed.

How are related endoscopies paid when performed together?

CMS endoscopy family pricing adjusts payment when related endoscopies are performed in the same session. Report the services supported by the procedure documentation.

Does 43231 have a global period or bilateral adjustment?

It has a 0-day global period, with same-day preoperative and postoperative care included. Modifier 50 is inappropriate for this service.

Can an assistant or additional surgeons be reported?

CMS does not pay an assistant at surgery for this code. Co-surgeons are permitted, but team surgery is not.

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 43231PPRRVU2026_Oct_nonQPP.csv, line 5,160 (RVU26D)

Open CMS sourceHow we calculate rates

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