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CPT code 43236: Submucosal injection, directed injection2026 Medicare rate & RVUs in Washington, DC area

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 Washington, DC area, Medicare pays $515.43 for 43236 in the office and $135.34 when it’s performed in a hospital or facility.

$515.43Office (non-facility)
$135.34Hospital or facility
+15.5%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 Washington, DC area
  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 Washington, DC area 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. Washington, DC area pays $515.43. The RVUs are the same everywhere; the geographic indexes change the dollars.

43236 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$515.43
  2. Los Angeles, CA · California$512.17−$3.26
  3. Miami, FL · Florida$474.76−$40.67
  4. Chicago, IL · Illinois$460.26−$55.17
  5. Manhattan, NY · New York$514.72−$0.71
  6. Alaska · Alaska$504.46−$10.97
  7. Alabama · Alabama$397.40−$118.03

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

43236 in every other Medicare payment locality
Payment localityOfficeFacility
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
Madera, 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 Washington, DC area 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

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 43236 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work2.33× 1.0542.4558
Practice expense10.76× 1.17812.6753
Malpractice0.27× 1.1130.3005
Total RVUs15.4316
Conversion factor× 33.4009

Office rate, Washington, DC area$515.43

Office: (2.33 × 1.054 + 10.76 × 1.178 + 0.27 × 1.113) × $33.4009 = $515.43

Facility: (2.33 × 1.054 + 1.1 × 1.178 + 0.27 × 1.113) × $33.4009 = $135.34

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, Washington, DC area
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.$371.11
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.$483.17

How 43236 has changed in Washington, DC area

43236 · Office / nonfacility

$515.43

Effective 2026-10-01

The base rate is $73.43 higher than on 2025-10-01, moving from $442.00 to $515.43 (16.6%).

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

    $442.00changed to$515.43

    • 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 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $465.96changed to$442.00

    • 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

    $458.35changed to$465.96

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $484.32changed to$458.35

    • 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 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $515.84changed to$484.32

    • 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 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $506.33changed to$515.84

    • 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

    $455.01changed to$506.33

    • 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 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $421.57changed to$455.01

    • 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 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $393.76changed to$421.57

    • 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

    $391.18changed to$393.76

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.64 changed to 6.68
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $461.74changed to$391.18

    • 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 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $472.15changed to$461.74

    • 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

    $469.80changed to$472.15

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $462.82changed to$469.80

    • 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
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $462.74changed to$462.82

    • 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
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $462.74

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$515.43$135.34RVU26D
2026-07-01$515.43$135.34RVU26C
2026-04-01$515.43$135.34RVU26B
2026-01-01$515.43$135.34RVU26A
2025-10-01$442.00$147.42RVU25D
2025-07-01$442.00$147.42RVU25C
2025-04-01$442.00$147.42RVU25B
2025-01-01$442.00$147.42RVU25A
2024-10-01$465.96$151.70RVU24D
2024-07-01$465.96$151.70RVU24C
2024-04-01$465.96$151.70RVU24B
2024-03-09$465.96$151.70RVU24AR
2024-01-01$458.35$149.23RVU24A
2023-10-01$484.32$153.56RVU23D
2023-07-01$484.32$153.56RVU23C
2023-04-01$484.32$153.56RVU23B
2023-01-01$484.32$153.56RVU23A
2022-10-01$515.84$157.40RVU22D
2022-07-01$515.84$157.40RVU22C
2022-04-01$515.84$157.40RVU22B
2022-01-01$515.84$157.40RVU22A
2021-10-01$506.33$158.72RVU21D
2021-07-01$506.33$158.72RVU21C
2021-04-01$506.33$158.72RVU21B
2021-01-01$506.33$158.72RVU21A
2020-10-01$455.01$161.53RVU20D
2020-07-01$455.01$161.53RVU20C
2020-04-01$455.01$161.53RVU20B
2020-01-01$455.01$161.53RVU20A
2019-10-01$421.57$162.74RVU19D
2019-07-01$421.57$162.74RVU19C
2019-04-01$421.57$162.74RVU19B
2019-01-01$421.57$162.74RVU19A
2018-10-01$393.76$163.41RVU18D
2018-07-01$393.76$163.41RVU18C
2018-04-01$393.76$163.41RVU18B
2018-01-01$393.76$163.41RVU18AR1
2017-10-01$391.18$163.28RVU17D
2017-07-01$391.18$163.28RVU17C
2017-04-01$391.18$163.28RVU17B
2017-01-01$391.18$163.28RVU17A
2016-10-01$461.74$169.66RVU16D
2016-07-01$461.74$169.66RVU16C
2016-04-01$461.74$169.66RVU16B
2016-01-01$461.74$169.66RVU16A
2015-10-01$472.15$173.38RVU15D
2015-07-01$472.15$173.38RVU15C
2015-04-01$469.80$172.52RVU15B
2015-01-01$469.80$172.52RVU15A
2014-10-01$462.82$170.45RVU14D
2014-07-01$462.82$170.45RVU14C
2014-04-01$462.82$170.45RVU14B
2014-01-01$462.82$170.45RVU14A
2013-10-01$462.74$197.40RVU13D
2013-07-01$462.74$197.40RVU13C
2013-04-01$462.74$197.40RVU13B
2013-01-01$462.74$197.40RVU13AR

Price 43236 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

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 Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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