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CPT code 43236: Submucosal injection, directed injection2026 Medicare rate & RVUs in Connecticut

Reports upper GI endoscopy with directed injection into the submucosa, such as tattooing a lesion or lifting it for endoscopic treatment.

CMS RVU26DEffective Oct 1, 2026One payment locality13.8K Medicare services in 2024

In Connecticut, Medicare pays $477.36 for 43236 in the office and $129.86 when it’s performed in a hospital or facility.

$477.36Office (non-facility)
$129.86Hospital or facility
+7.0%vs the national office rate ($446.24)

Check a contract rate as a % of Medicare · 43236 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 43236 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 43236 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 43236 covers

During an upper GI endoscopy, the physician directs a substance into the submucosal layer of the esophagus, stomach, or duodenum. Common purposes include placing tattoo ink to help locate a lesion later or injecting a lifting solution beneath a lesion before endoscopic treatment. Gastroenterologists and other physicians who perform upper endoscopy may provide the service in an office endoscopy suite or a hospital outpatient endoscopy unit.

Select this code when the procedure documentation supports directed submucosal injection, not merely diagnostic inspection or tissue sampling. Record the injection site, substance, purpose, endoscopic findings, and any other intervention performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery for this service, 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 Connecticut compares for 43236

Across 109 of 109 payment localities, the office rate for 43236 runs from $391.19 in Arkansas to $609.46 in San Benito County, CA. Connecticut pays $477.36. The RVUs are the same everywhere; the geographic indexes change the dollars.

43236 in Connecticut vs other payment areas
  1. Connecticut · this page$477.36
  2. Los Angeles, CA · California$512.17+$34.81
  3. Washington, DC area · District of Columbia$515.43+$38.07
  4. Miami, FL · Florida$474.76−$2.60
  5. Chicago, IL · Illinois$460.26−$17.10
  6. Manhattan, NY · New York$514.72+$37.36
  7. Alaska · Alaska$504.46+$27.10

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

Every other payment area

43236 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$397.40$115.08
ArkansasArkansas$391.19$114.03
ArizonaArizona$433.80$121.15
Bakersfield, CACalifornia$478.69$125.06
Chico, CACalifornia$477.88$124.25
El Centro, CACalifornia$477.92$124.29
Fresno, CACalifornia$477.88$124.25
Hanford, CACalifornia$477.88$124.25

43236 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.

$391.19

$543.67

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

View every state and territory as a table
43236 office rate range by state
State / territoryOffice rate rangeLocalities
AK$504.461
AL$397.401
AR$391.191
AZ$433.801
CA$477.88–$609.4629
CO$468.201
CT$477.361
DC$515.431
DE$441.401
FL$434.96–$474.763
GA$409.15–$454.032
GU$491.681
HI$491.681
IA$410.251
ID$412.731
IL$420.05–$463.454
IN$415.361
KS$407.261
KY$405.581
LA$404.53–$426.262
MA$464.70–$518.162
MD$450.59–$515.433
ME$414.08–$439.672
MI$416.13–$439.842
MN$450.311
MO$396.41–$429.003
MS$393.931
MT$446.221
NC$418.901
ND$440.881
NE$412.951
NH$459.841
NJ$483.29–$509.262
NM$418.221
NV$445.091
NY$425.59–$526.875
OH$415.041
OK$405.771
OR$442.12–$485.072
PA$416.27–$464.112
PR$450.051
RI$458.601
SC$417.571
SD$440.251
TN$409.361
TX$413.25–$466.218
UT$423.751
VA$437.47–$515.432
VI$450.051
VT$438.191
WA$464.14–$530.062
WI$424.901
WV$403.041
WY$443.891

See 43236 in every payment locality

How the 43236 rate is calculated

Each of 43236’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 · 43236

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.33

2.33 RVUs× 1.000 GPCI

Practice expense10.76

10.76 RVUs× 1.000 GPCI

Malpractice0.27

0.27 RVUs× 1.000 GPCI

Adjusted RVUs

13.3600

Conversion factor

$33.4009

Medicare rate

$446.24

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

The exact Connecticut inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,164

Code
43236
Physician work
2.33
Practice expense
10.76
Malpractice
0.27

GPCI2026.csv

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 43236 in Connecticut
ComponentRVULocality factorAdjusted
Physician work2.33× 1.0202.3766
Practice expense10.76× 1.07711.5885
Malpractice0.27× 1.2100.3267
Total RVUs14.2918
Conversion factor× 33.4009

Office rate, Connecticut$477.36

Office: (2.33 × 1.02 + 10.76 × 1.077 + 0.27 × 1.21) × $33.4009 = $477.36

Facility: (2.33 × 1.02 + 1.1 × 1.077 + 0.27 × 1.21) × $33.4009 = $129.86

Open 43236 in the RVU calculator

Payment rules and modifiers for 43236

The CMS indicators that decide how 43236 is paid alongside other services.

CMS payment indicators · 43236

Submucosal injection, directed injection

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

43236 without 51 · national office

$446.24

Submucosal injection, directed injection

43236-51 · Second procedure: 50%

$223.12

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 43236

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

Codes related to 43236
CodeHow it relatesOffice range, Connecticut
Used instead
43243Variceal injection, esophageal or gastric varicesUse for endoscopic injection treatment of esophageal varices rather than general submucosal injection.No office rate
43235Upper GI endoscopy, diagnostic, brushings or washingsDescribes diagnostic upper GI endoscopy when no directed submucosal injection is performed.$344.68
43244Variceal ligation, esophageal or gastric varicesDescribes endoscopic variceal ligation when varices are treated by banding rather than injection.No office rate
Often billed with
43239EGD with biopsy, single or multiple biopsiesA separate biopsy may occur during the same EGD; apply coding edits and endoscopy-family pricing.$447.86

How 43236 has changed in Connecticut

43236 · Office / nonfacility

$477.36

Effective 2026-10-01

The base rate is $67.30 higher than on 2025-10-01, moving from $410.06 to $477.36 (16.4%).

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

    $410.06changed to$477.36

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.39 changed to 2.33
    • Practice expense RVU 9.06 changed to 10.76
    • Malpractice RVU 0.29 changed to 0.27
    • Work GPCI 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $432.20changed to$410.06

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 9.33 changed to 9.06
    • Malpractice RVU 0.30 changed to 0.29

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $425.14changed to$432.20

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $444.99changed to$425.14

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.42 changed to 9.33
    • Malpractice RVU 0.27 changed to 0.30
    • Work GPCI 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $470.11changed to$444.99

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.76 changed to 9.42
    • Malpractice RVU 0.25 changed to 0.27
    • Work GPCI 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $461.51changed to$470.11

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 9.43 changed to 9.76
    • Malpractice RVU 0.26 changed to 0.25

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $420.36changed to$461.51

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.99 changed to 9.43
    • Malpractice RVU 0.27 changed to 0.26
    • Work GPCI 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $394.97changed to$420.36

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.30 changed to 7.99
    • Malpractice RVU 0.32 changed to 0.27
    • Work GPCI 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $369.26changed to$394.97

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.68 changed to 7.30
    • Malpractice RVU 0.31 changed to 0.32

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $367.77changed to$369.26

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.64 changed to 6.68
    • Work GPCI 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $434.17changed to$367.77

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.49 changed to 2.39
    • Practice expense RVU 8.18 changed to 6.64
    • Malpractice RVU 0.33 changed to 0.31
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $443.91changed to$434.17

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.35 changed to 8.18
    • Malpractice RVU 0.36 changed to 0.33

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $441.70changed to$443.91

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $435.46changed to$441.70

    • Conversion factor 35.8228 changed to 35.7547
    • Work RVU 2.47 changed to 2.49
    • Practice expense RVU 8.25 changed to 8.35
    • Malpractice RVU 0.34 changed to 0.36
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $436.61changed to$435.46

    • Conversion factor 34.0230 changed to 35.8228
    • Work RVU 2.92 changed to 2.47
    • Practice expense RVU 8.40 changed to 8.25
    • Malpractice RVU 0.42 changed to 0.34
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $436.61

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$477.36$129.86RVU26D
2026-07-01$477.36$129.86RVU26C
2026-04-01$477.36$129.86RVU26B
2026-01-01$477.36$129.86RVU26A
2025-10-01$410.06$140.44RVU25D
2025-07-01$410.06$140.44RVU25C
2025-04-01$410.06$140.44RVU25B
2025-01-01$410.06$140.44RVU25A
2024-10-01$432.20$144.57RVU24D
2024-07-01$432.20$144.57RVU24C
2024-04-01$432.20$144.57RVU24B
2024-03-09$432.20$144.57RVU24AR
2024-01-01$425.14$142.21RVU24A
2023-10-01$444.99$144.74RVU23D
2023-07-01$444.99$144.74RVU23C
2023-04-01$444.99$144.74RVU23B
2023-01-01$444.99$144.74RVU23A
2022-10-01$470.11$147.05RVU22D
2022-07-01$470.11$147.05RVU22C
2022-04-01$470.11$147.05RVU22B
2022-01-01$470.11$147.05RVU22A
2021-10-01$461.51$148.21RVU21D
2021-07-01$461.51$148.21RVU21C
2021-04-01$461.51$148.21RVU21B
2021-01-01$461.51$148.21RVU21A
2020-10-01$420.36$152.84RVU20D
2020-07-01$420.36$152.84RVU20C
2020-04-01$420.36$152.84RVU20B
2020-01-01$420.36$152.84RVU20A
2019-10-01$394.97$156.12RVU19D
2019-07-01$394.97$156.12RVU19C
2019-04-01$394.97$156.12RVU19B
2019-01-01$394.97$156.12RVU19A
2018-10-01$369.26$156.69RVU18D
2018-07-01$369.26$156.69RVU18C
2018-04-01$369.26$156.69RVU18B
2018-01-01$369.26$156.69RVU18AR1
2017-10-01$367.77$156.51RVU17D
2017-07-01$367.77$156.51RVU17C
2017-04-01$367.77$156.51RVU17B
2017-01-01$367.77$156.51RVU17A
2016-10-01$434.17$162.44RVU16D
2016-07-01$434.17$162.44RVU16C
2016-04-01$434.17$162.44RVU16B
2016-01-01$434.17$162.44RVU16A
2015-10-01$443.91$165.97RVU15D
2015-07-01$443.91$165.97RVU15C
2015-04-01$441.70$165.14RVU15B
2015-01-01$441.70$165.14RVU15A
2014-10-01$435.46$164.00RVU14D
2014-07-01$435.46$164.00RVU14C
2014-04-01$435.46$164.00RVU14B
2014-01-01$435.46$164.00RVU14A
2013-10-01$436.61$190.76RVU13D
2013-07-01$436.61$190.76RVU13C
2013-04-01$436.61$190.76RVU13B
2013-01-01$436.61$190.76RVU13AR

Price 43236 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

43236 billing questions

When should this code be chosen instead of 43243?

Use 43236 for directed submucosal injection such as lesion marking or lifting. Code 43243 describes injection treatment of esophageal varices.

Is the code reported once for each injection site?

The code describes the endoscopic injection service, including one or more injections. Documentation should identify the treated site or sites and the purpose.

Can biopsy or lesion removal also be reported?

The injection service is distinct from tissue sampling or lesion removal, but same-session reporting depends on applicable coding edits. CMS endoscopy-family pricing applies when related endoscopies are performed together.

Should modifier 50 be appended?

No. CMS identifies bilateral adjustment as inappropriate for this code.

Can an assistant, co-surgeon, or surgical team be paid?

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 43236PPRRVU2026_Oct_nonQPP.csv, line 5,164 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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