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CPT code 43237: Endoscopic ultrasound, limited upper GI examination2026 Medicare rate & RVUs

Upper gastrointestinal endoscopic ultrasound evaluates the esophageal, gastric, or duodenal wall and nearby structures when imaging beyond standard endoscopy is needed.

CMS RVU26DEffective Oct 1, 2026109 payment localities21.3K Medicare services in 2024

Medicare pays $173.02 for 43237 nationally in a facility.

Medicare rate · 43237

Endoscopic ultrasound, limited upper GI examination

Office or facility?

Work RVUs
3.38
Total RVUs
5.18
Global days
000

National rate · 2026

$173.02

Facility setting, before claim adjustments.

See every locality for 43237 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 43237 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43237 covers

A gastroenterologist advances an endoscope with an ultrasound probe to assess the wall of the esophagus, stomach, or duodenum and adjacent structures. Common reasons include evaluating a subepithelial lesion, assessing wall layers, or examining nearby lymph nodes or pancreaticobiliary structures that are within the scope of the study. The service is performed in an endoscopy unit, ambulatory surgery center, or hospital facility.

Report this code when the EUS examination is limited to the specified upper gastrointestinal region and no EUS-guided needle aspiration or biopsy is performed. Document the indication, anatomic extent, structures examined, findings, and any sampling performed; needle sampling changes the code selection. 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, and CMS does not pay an assistant at surgery, co-surgeons, or a team of surgeons for this service.

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.

Where 43237 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43237 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$161.58
AlaskaUnavailable$226.85
ArizonaUnavailable$169.72
ArkansasUnavailable$160.17
Atlanta, GAUnavailable$176.67
Austin, TXUnavailable$174.55
Bakersfield, CAUnavailable$174.75
Baltimore area, MDUnavailable$181.29
Beaumont, TXUnavailable$167.85
Brazoria, TXUnavailable$170.70

43237 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
43237 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43237 rate is calculated

Each of 43237’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 · 43237

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.38

3.38 RVUs× 1.000 GPCI

Practice expense1.42

1.42 RVUs× 1.000 GPCI

Malpractice0.38

0.38 RVUs× 1.000 GPCI

Adjusted RVUs

5.1800

Conversion factor

$33.4009

Medicare rate

$173.02

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

Payment rules and modifiers for 43237

The CMS indicators that decide how 43237 is paid alongside other services.

CMS payment indicators · 43237

Endoscopic ultrasound, limited upper GI examination

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

43237 without 51 · national facility

$173.02

Endoscopic ultrasound, limited upper GI examination

43237-51 · Second procedure: 50%

$86.51

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

43237 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 43237

    Endoscopic ultrasound, limited upper GI examination3.38 wRVU

    Not priced

  • 43238

    EUS-guided biopsy, limited upper GI examination4.06 wRVU

    Not priced

  • 43259

    Endoscopic ultrasound, diagnostic examination3.94 wRVU

    Not priced

  • 43231

    Esophageal EUS, examination only, esophagus2.73 wRVU

    Not priced

  • 43239

    EGD with biopsy, single or multiple biopsies2.33 wRVU

    $418.85

How to choose

43238EUS-guided biopsyLimited upper GI examination
43237 is for the limited EUS examination without EUS-guided needle sampling. Choose 43238 when the applicable EGD/EUS service includes needle aspiration or biopsy.
43259Endoscopic ultrasoundDiagnostic examination
43237 is limited to the specified upper gastrointestinal region. 43259 describes an EUS examination with a broader anatomic extent.
43231Esophageal EUSExamination only, esophagus
43231 uses esophagoscopy for an EUS examination limited to the esophagus; 43237 is the EGD-based service for the specified upper GI regions.
43239EGD with biopsySingle or multiple biopsies
43239 covers conventional mucosal biopsy during EGD. It is not the code for EUS-guided needle sampling of a lesion.

Codes related to 43237

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

Codes related to 43237
CodeHow it relatesNational office range
Used instead
43238EUS-guided biopsy, limited upper GI examinationUse the applicable EGD/EUS needle-sampling code when ultrasound-guided aspiration or biopsy is performed.No office rate
43259Endoscopic ultrasound, diagnostic examinationFor an EUS examination that includes the broader anatomic extent specified for that code.No office rate
43231Esophageal EUS, examination only, esophagusEsophagoscopy with EUS when the examination is limited to the esophagus.No office rate
43232Esophageal EUS, EUS-guided needle samplingEsophagoscopy with EUS-guided needle aspiration or biopsy.No office rate

43237 billing questions

When should 43237 be used instead of 43238?

Use 43237 for the limited EUS examination without EUS-guided needle aspiration or biopsy. When needle sampling is performed, use the applicable sampling code, such as 43238.

Can the diagnostic EGD be billed separately with 43237?

The endoscopic access and examination needed to perform the EUS are part of the service. Do not separately report a diagnostic EGD for that same examination.

How does 43237 differ from 43259?

43237 describes an examination limited to the esophagus, stomach, or duodenum and adjacent structures. Use 43259 when the examination includes the broader anatomic extent specified for that code.

Should modifier 50 be appended for bilateral findings?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.

What documentation supports reporting 43237?

Document why EUS was needed, the anatomic region examined, the structures assessed, and the findings. State whether needle aspiration or biopsy occurred, since that affects code selection.

Are assistant surgeon or co-surgeon services payable with 43237?

CMS does not pay an assistant at surgery for this service and does not permit co-surgeons or team surgery.

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 43237PPRRVU2026_Oct_nonQPP.csv, line 5,165 (RVU26D)

Open CMS sourceHow we calculate rates

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