FeeBase
Log inGet started
Menu

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

Reports a flexible upper endoscopic examination of the esophagus, stomach, and duodenum, including brush or wash cytology when performed without biopsy or therapy.

CMS RVU26DEffective Oct 1, 2026One payment locality262.6K Medicare services in 2024

In West Virginia, Medicare pays $293.82 for 43235 in the office and $109.51 when it’s performed in a hospital or facility.

$293.82Office (non-facility)
$109.51Hospital or facility
−8.9%vs the national office rate ($322.65)

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.

We’ll open 43235 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in West Virginia
  2. What 43235 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 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 West Virginia 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. West Virginia pays $293.82. The RVUs are the same everywhere; the geographic indexes change the dollars.

43235 in West Virginia vs other payment areas
  1. West Virginia · this page$293.82
  2. Los Angeles, CA · California$367.86+$74.04
  3. Washington, DC area · District of Columbia$371.11+$77.29
  4. Miami, FL · Florida$345.02+$51.20
  5. Chicago, IL · Illinois$334.74+$40.92
  6. Manhattan, NY · New York$371.64+$77.82
  7. Alaska · Alaska$369.14+$75.32

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

Every other payment area

43235 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$288.36$102.78
ArkansasArkansas$284.01$101.82
ArizonaArizona$313.86$108.34
Bakersfield, CACalifornia$344.48$112.02
Chico, CACalifornia$343.76$111.30
El Centro, CACalifornia$343.80$111.34
Fresno, CACalifornia$343.76$111.30
Hanford, CACalifornia$343.76$111.30

43235 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.

$284.01

$389.57

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

View every state and territory as a table
43235 office rate range by state
State / territoryOffice rate rangeLocalities
AK$369.141
AL$288.361
AR$284.011
AZ$313.861
CA$343.76–$435.3829
CO$337.491
CT$344.681
DC$371.111
DE$319.231
FL$315.84–$345.023
GA$297.57–$328.412
GU$353.051
HI$353.051
IA$296.871
ID$298.711
IL$305.72–$335.974
IN$300.541
KS$295.011
KY$294.611
LA$293.97–$309.202
MA$335.18–$372.392
MD$325.63–$371.113
ME$299.90–$317.482
MI$302.24–$319.522
MN$324.161
MO$288.43–$310.843
MS$286.301
MT$322.641
NC$303.241
ND$317.891
NE$298.691
NH$331.761
NJ$348.83–$366.932
NM$303.801
NV$321.561
NY$307.95–$380.475
OH$301.271
OK$294.491
OR$319.29–$349.052
PA$302.00–$335.532
PR$325.241
RI$331.221
SC$302.721
SD$317.331
TN$296.511
TX$299.90–$336.178
UT$307.051
VA$316.11–$371.112
VI$325.241
VT$316.231
WA$334.69–$380.552
WI$306.751
WV$293.821
WY$320.571

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.

How the rate is built · 43235

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.04

2.04 RVUs× 1.000 GPCI

Practice expense7.38

7.38 RVUs× 1.000 GPCI

Malpractice0.24

0.24 RVUs× 1.000 GPCI

Adjusted RVUs

9.6600

Conversion factor

$33.4009

Medicare rate

$322.65

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

The exact West Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,163

Code
43235
Physician work
2.04
Practice expense
7.38
Malpractice
0.24

GPCI2026.csv

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 43235 in West Virginia
ComponentRVULocality factorAdjusted
Physician work2.04× 1.0002.0400
Practice expense7.38× 0.8696.4132
Malpractice0.24× 1.4310.3434
Total RVUs8.7967
Conversion factor× 33.4009

Office rate, West Virginia$293.82

Office: (2.04 × 1 + 7.38 × 0.869 + 0.24 × 1.431) × $33.4009 = $293.82

Facility: (2.04 × 1 + 1.03 × 0.869 + 0.24 × 1.431) × $33.4009 = $109.51

Open 43235 in the RVU calculator

Payment rules and modifiers for 43235

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

CMS payment indicators · 43235

Upper GI endoscopy, diagnostic, brushings or washings

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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

43235 without 51 · national office

$322.65

Upper GI endoscopy, diagnostic, brushings or washings

43235-51 · Second procedure: 50%

$161.33

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 43235

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

Codes related to 43235
CodeHow it relatesOffice range, West Virginia
Same family
43239EGD with biopsy, single or multiple biopsiesUpper endoscopy with forceps biopsy rather than diagnostic inspection with brush or wash sampling.$379.24
Used instead
43237Endoscopic ultrasound, limited upper GI examinationUse when the upper endoscopy includes an endoscopic ultrasound examination.No office rate
43238EUS-guided biopsy, limited upper GI examinationUse when the upper endoscopy includes ultrasound-guided fine needle sampling.No office rate
43245EGD dilation, gastric outlet obstructionUse when the upper endoscopy includes dilation of a stricture.$590.20

How 43235 has changed in West Virginia

43235 · Office / nonfacility

$293.82

Effective 2026-10-01

The base rate is $42.26 higher than on 2025-10-01, moving from $251.56 to $293.82 (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

    $251.56changed to$293.82

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.09 changed to 2.04
    • Practice expense RVU 6.18 changed to 7.38
    • Malpractice RVU 0.27 changed to 0.24
    • Practice expense GPCI 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $261.30changed to$251.56

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.28 changed to 6.18
    • Malpractice RVU 0.26 changed to 0.27

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $257.04changed to$261.30

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $265.87changed to$257.04

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.31 changed to 6.28
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $283.11changed to$265.87

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.75 changed to 6.31
    • Malpractice RVU 0.25 changed to 0.26
    • Practice expense GPCI 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $280.67changed to$283.11

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.59 changed to 6.75

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $261.26changed to$280.67

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.63 changed to 6.59
    • Malpractice RVU 0.26 changed to 0.25
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $250.24changed to$261.26

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.24 changed to 5.63
    • Malpractice RVU 0.28 changed to 0.26
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $240.87changed to$250.24

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.93 changed to 5.24
    • Malpractice RVU 0.29 changed to 0.28

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $237.37changed to$240.87

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.90 changed to 4.93
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $282.25changed to$237.37

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.19 changed to 2.09
    • Practice expense RVU 6.35 changed to 4.90
    • Malpractice RVU 0.30 changed to 0.29
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $288.26changed to$282.25

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 6.47 changed to 6.35
    • Malpractice RVU 0.33 changed to 0.30

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $286.82changed to$288.26

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $282.44changed to$286.82

    • Conversion factor 35.8228 changed to 35.7547
    • Work RVU 2.17 changed to 2.19
    • Practice expense RVU 6.37 changed to 6.47
    • Practice expense GPCI 0.832 changed to 0.836
    • Malpractice GPCI 1.256 changed to 1.282

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $277.08changed to$282.44

    • Conversion factor 34.0230 changed to 35.8228
    • Work RVU 2.39 changed to 2.17
    • Practice expense RVU 6.40 changed to 6.37
    • Malpractice RVU 0.37 changed to 0.33
    • Practice expense GPCI 0.828 changed to 0.832
    • Malpractice GPCI 1.229 changed to 1.256

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $277.08

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$293.82$109.51RVU26D
2026-07-01$293.82$109.51RVU26C
2026-04-01$293.82$109.51RVU26B
2026-01-01$293.82$109.51RVU26A
2025-10-01$251.56$115.21RVU25D
2025-07-01$251.56$115.21RVU25C
2025-04-01$251.56$115.21RVU25B
2025-01-01$251.56$115.21RVU25A
2024-10-01$261.30$117.84RVU24D
2024-07-01$261.30$117.84RVU24C
2024-04-01$261.30$117.84RVU24B
2024-03-09$261.30$117.84RVU24AR
2024-01-01$257.04$115.91RVU24A
2023-10-01$265.87$118.41RVU23D
2023-07-01$265.87$118.41RVU23C
2023-04-01$265.87$118.41RVU23B
2023-01-01$265.87$118.41RVU23A
2022-10-01$283.11$119.81RVU22D
2022-07-01$283.11$119.81RVU22C
2022-04-01$283.11$119.81RVU22B
2022-01-01$283.11$119.81RVU22A
2021-10-01$280.67$120.20RVU21D
2021-07-01$280.67$120.20RVU21C
2021-04-01$280.67$120.20RVU21B
2021-01-01$280.67$120.20RVU21A
2020-10-01$261.26$123.93RVU20D
2020-07-01$261.26$123.93RVU20C
2020-04-01$261.26$123.93RVU20B
2020-01-01$261.26$123.93RVU20A
2019-10-01$250.24$125.77RVU19D
2019-07-01$250.24$125.77RVU19C
2019-04-01$250.24$125.77RVU19B
2019-01-01$250.24$125.77RVU19A
2018-10-01$240.87$126.72RVU18D
2018-07-01$240.87$126.72RVU18C
2018-04-01$240.87$126.72RVU18B
2018-01-01$240.87$126.72RVU18AR1
2017-10-01$237.37$125.81RVU17D
2017-07-01$237.37$125.81RVU17C
2017-04-01$237.37$125.81RVU17B
2017-01-01$237.37$125.81RVU17A
2016-10-01$282.25$129.90RVU16D
2016-07-01$282.25$129.90RVU16C
2016-04-01$282.25$129.90RVU16B
2016-01-01$282.25$129.90RVU16A
2015-10-01$288.26$132.95RVU15D
2015-07-01$288.26$132.95RVU15C
2015-04-01$286.82$132.29RVU15B
2015-01-01$286.82$132.29RVU15A
2014-10-01$282.44$131.33RVU14D
2014-07-01$282.44$131.33RVU14C
2014-04-01$282.44$131.33RVU14B
2014-01-01$282.44$131.33RVU14A
2013-10-01$277.08$141.58RVU13D
2013-07-01$277.08$141.58RVU13C
2013-04-01$277.08$141.58RVU13B
2013-01-01$277.08$141.58RVU13AR

Price 43235 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

43235 billing questions

When should 43239 be reported instead?

Use 43239 when forceps biopsy is performed during the upper endoscopy. Do not separately report this diagnostic examination for the same session.

Are brushings or washings separately billable?

No. Brushings or washings, when performed as part of the diagnostic examination, are included in 43235.

Can 43235 be reported with an endoscopic treatment?

When the same session includes a therapeutic upper endoscopic procedure, report the procedure performed rather than separately reporting the diagnostic examination.

Should modifier 50 be appended?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.

How does Medicare handle multiple procedures in one session?

The highest-valued procedure is paid in full; other procedures in the same session are paid at 50%. The 0-day global period includes same-day preoperative and postoperative care.

Can an assistant or co-surgeon be billed for this procedure?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery 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 43235PPRRVU2026_Oct_nonQPP.csv, line 5,163 (RVU26D)
Geographic factors for West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 43235 pays in West Virginia?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 43235 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist