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

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 Indiana, Medicare pays $415.36 for 43236 in the office and $116.27 when it’s performed in a hospital or facility.

$415.36Office (non-facility)
$116.27Hospital or facility
−6.9%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 Indiana
  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 Indiana 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. Indiana pays $415.36. The RVUs are the same everywhere; the geographic indexes change the dollars.

43236 in Indiana vs other payment areas
  1. Indiana · this page$415.36
  2. Los Angeles, CA · California$512.17+$96.81
  3. Washington, DC area · District of Columbia$515.43+$100.07
  4. Miami, FL · Florida$474.76+$59.40
  5. Chicago, IL · Illinois$460.26+$44.90
  6. Manhattan, NY · New York$514.72+$99.36
  7. Alaska · Alaska$504.46+$89.10

Other areas in Indiana 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 Indiana 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

52

Locality
Indiana
Physician work
1.000
Practice expense
0.927
Malpractice
0.486
Office calculation for 43236 in Indiana
ComponentRVULocality factorAdjusted
Physician work2.33× 1.0002.3300
Practice expense10.76× 0.9279.9745
Malpractice0.27× 0.4860.1312
Total RVUs12.4357
Conversion factor× 33.4009

Office rate, Indiana$415.36

Office: (2.33 × 1 + 10.76 × 0.927 + 0.27 × 0.486) × $33.4009 = $415.36

Facility: (2.33 × 1 + 1.1 × 0.927 + 0.27 × 0.486) × $33.4009 = $116.27

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, Indiana
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.$300.54
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.$389.98

How 43236 has changed in Indiana

43236 · Office / nonfacility

$415.36

Effective 2026-10-01

The base rate is $63.30 higher than on 2025-10-01, moving from $352.06 to $415.36 (18.0%).

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

    $352.06changed to$415.36

    • 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
    • Practice expense GPCI 0.922 changed to 0.927
    • Malpractice GPCI 0.485 changed to 0.486

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $370.75changed to$352.06

    • 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

    $364.70changed to$370.75

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $376.14changed to$364.70

    • 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
    • Practice expense GPCI 0.911 changed to 0.922
    • Malpractice GPCI 0.475 changed to 0.485

  5. January 1, 2023

    RVU23A

    $390.71changed to$376.14

    • 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
    • Practice expense GPCI 0.900 changed to 0.911
    • Malpractice GPCI 0.465 changed to 0.475

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $383.75changed to$390.71

    • 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

    $352.77changed to$383.75

    • 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
    • Practice expense GPCI 0.910 changed to 0.900
    • Malpractice GPCI 0.422 changed to 0.465

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $332.28changed to$352.77

    • 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
    • Practice expense GPCI 0.919 changed to 0.910
    • Malpractice GPCI 0.379 changed to 0.422

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $311.27changed to$332.28

    • 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

    $310.55changed to$311.27

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.64 changed to 6.68
    • Practice expense GPCI 0.920 changed to 0.919
    • Malpractice GPCI 0.498 changed to 0.379

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $366.18changed to$310.55

    • 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
    • Practice expense GPCI 0.921 changed to 0.920
    • Malpractice GPCI 0.617 changed to 0.498

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $373.80changed to$366.18

    • 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

    $371.94changed to$373.80

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $368.46changed to$371.94

    • 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 0.922 changed to 0.921
    • Malpractice GPCI 0.615 changed to 0.617

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $371.89changed to$368.46

    • 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 0.923 changed to 0.922
    • Malpractice GPCI 0.613 changed to 0.615

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $371.89

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$415.36$116.27RVU26D
2026-07-01$415.36$116.27RVU26C
2026-04-01$415.36$116.27RVU26B
2026-01-01$415.36$116.27RVU26A
2025-10-01$352.06$124.21RVU25D
2025-07-01$352.06$124.21RVU25C
2025-04-01$352.06$124.21RVU25B
2025-01-01$352.06$124.21RVU25A
2024-10-01$370.75$127.67RVU24D
2024-07-01$370.75$127.67RVU24C
2024-04-01$370.75$127.67RVU24B
2024-03-09$370.75$127.67RVU24AR
2024-01-01$364.70$125.59RVU24A
2023-10-01$376.14$127.94RVU23D
2023-07-01$376.14$127.94RVU23C
2023-04-01$376.14$127.94RVU23B
2023-01-01$376.14$127.94RVU23A
2022-10-01$390.71$129.71RVU22D
2022-07-01$390.71$129.71RVU22C
2022-04-01$390.71$129.71RVU22B
2022-01-01$390.71$129.71RVU22A
2021-10-01$383.75$130.64RVU21D
2021-07-01$383.75$130.64RVU21C
2021-04-01$383.75$130.64RVU21B
2021-01-01$383.75$130.64RVU21A
2020-10-01$352.77$134.05RVU20D
2020-07-01$352.77$134.05RVU20C
2020-04-01$352.77$134.05RVU20B
2020-01-01$352.77$134.05RVU20A
2019-10-01$332.28$134.88RVU19D
2019-07-01$332.28$134.88RVU19C
2019-04-01$332.28$134.88RVU19B
2019-01-01$332.28$134.88RVU19A
2018-10-01$311.27$135.59RVU18D
2018-07-01$311.27$135.59RVU18C
2018-04-01$311.27$135.59RVU18B
2018-01-01$311.27$135.59RVU18AR1
2017-10-01$310.55$136.55RVU17D
2017-07-01$310.55$136.55RVU17C
2017-04-01$310.55$136.55RVU17B
2017-01-01$310.55$136.55RVU17A
2016-10-01$366.18$142.94RVU16D
2016-07-01$366.18$142.94RVU16C
2016-04-01$366.18$142.94RVU16B
2016-01-01$366.18$142.94RVU16A
2015-10-01$373.80$145.44RVU15D
2015-07-01$373.80$145.44RVU15C
2015-04-01$371.94$144.72RVU15B
2015-01-01$371.94$144.72RVU15A
2014-10-01$368.46$144.19RVU14D
2014-07-01$368.46$144.19RVU14C
2014-04-01$368.46$144.19RVU14B
2014-01-01$368.46$144.19RVU14A
2013-10-01$371.89$167.46RVU13D
2013-07-01$371.89$167.46RVU13C
2013-04-01$371.89$167.46RVU13B
2013-01-01$371.89$167.46RVU13AR

Price 43236 for an earlier date of service

Where the Indiana rate applies

Indiana is a Medicare payment area, not a city. Our Census mapping connects it to 974 cities and communities in Indiana. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Abington
  • Adams
  • Adams Lake
  • Advance
  • Akron
  • Alamo
  • Albany

Browse all communities in Indiana

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 IndianaGPCI2026.csv, line 52 (RVU26D)

Open CMS sourceHow we calculate rates

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