CPT code 43235: Upper GI endoscopy, diagnostic, brushings or washings2026 Medicare rate & RVUs in North Dakota

In North Dakota, Medicare pays $317.89 for 43235 in the office and $105.80 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 43235 nationwide

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

What 43235 covers

A flexible scope is passed through the mouth to examine the esophagus, stomach, and duodenum. When performed, brushings or washings collect cells or material for laboratory analysis; they are part of this service. Gastroenterologists and other physicians trained in upper endoscopy perform it in office, ambulatory, and hospital settings to evaluate upper gastrointestinal symptoms or findings when the examination is diagnostic.

Report this code when inspection, with or without brushings or washings, is performed without a biopsy or therapeutic intervention. The record should support the examined anatomy, findings, and any sampled site and method. A biopsy or endoscopic treatment calls for the corresponding procedure code rather than separate reporting of this diagnostic examination. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate; assistant-at-surgery services are not paid, 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 North Dakota compares for 43235

Across 109 of 109 payment localities, the office rate for 43235 runs from $284.01 in Arkansas to $435.38 in San Benito County, CA. North Dakota pays $317.89. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43235 rates by state

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

See 43235 in every payment locality

How the 43235 rate is calculated

Each of 43235’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.

Payment rules and modifiers for 43235

The CMS indicators that decide how 43235 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 43235

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

How 43235 has changed in North Dakota

Price 43235 for an earlier date of service

Where the North Dakota rate applies

North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.

• Abercrombie
• Adams
• Alamo
• Alexander
• Alice
• Almont
• Alsen
• Ambrose

Browse all communities in North Dakota

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

Open CMS sourceHow we calculate rates