CPT code 43238: EUS-guided biopsy, limited upper GI examination2026 Medicare rate & RVUs in Aromas, California
CPT 43238: $210.40–$236.43 facility across 2 localities in Aromas, CA in 2026 Medicare. Compare each area.
CMS doesn’t publish an office rate for 43238 in Aromas, California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 6 sections
Where 43238 pays more and less in Aromas, California
Aromas, California maps to 2 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
| Payment locality | Office | Facility |
|---|---|---|
| Salinas, CA | Unavailable | $210.40 |
| San Benito County, CA | Unavailable | $236.43 |
How payment areas work in Aromas
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- Monterey · Monterey County
- San Benito · San Benito County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
How the 43238 rate is calculated
Each of 43238’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 · 43238
RVUs × geographic indexes × conversion factor
Work4.06
4.06 RVUs× 1.000 GPCI
Practice expense1.62
1.62 RVUs× 1.000 GPCI
Malpractice0.44
0.44 RVUs× 1.000 GPCI
Adjusted RVUs
6.1200
Conversion factor
$33.4009
Medicare rate
$204.41
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43238
The CMS indicators that decide how 43238 is paid alongside other services.
CMS payment indicators · 43238
EUS-guided biopsy, limited upper GI examination
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43238 without 51 · national facility
$204.41
EUS-guided biopsy, limited upper GI examination
43238-51 · Second procedure: 50%
$102.21
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%).
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
Fee sheets · Coming soon
Put 43238 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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