CPT code 43238: EUS-guided biopsy, limited upper GI examination2026 Medicare rate & RVUs in Virginia

In Virginia, Medicare pays $199.17 for 43238 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43238 nationwide

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

What 43238 covers

A gastroenterologist performs this service by passing an endoscope through the mouth and using endoscopic ultrasound to guide a needle into a target for aspiration or tissue sampling. Typical targets include a subepithelial stomach lesion, a pancreatic mass, or a suspicious lymph node near the upper gastrointestinal tract. The service is commonly performed in a hospital endoscopy unit or ambulatory endoscopy setting when imaging and tissue acquisition are needed during the same procedure.

Choose 43238 when the EUS examination is limited to the relevant portion of the esophagus, stomach, or duodenum and adjacent structures, and needle sampling is performed. The report should identify the target, ultrasound-guided sampling, and the extent of the examination; the code includes the EUS examination and sampling, rather than a separately billed diagnostic EUS. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Endoscopy family pricing applies when related endoscopies are performed together. Modifier 50 is inappropriate for this anatomy. CMS does not pay an assistant at surgery and does not permit co-surgeon or team-surgery billing 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.

How Virginia compares for 43238

Across 109 of 109 payment localities, the facility rate for 43238 runs from $189.66 in Arkansas to $269.14 in Alaska. Virginia pays $199.17. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43238 rates by state

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

See 43238 in every payment locality

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.

Payment rules and modifiers for 43238

The CMS indicators that decide how 43238 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 43238

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

How 43238 has changed in Virginia

Price 43238 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

• Abbs Valley
• Abingdon
• Accomac
• Adwolf
• Afton
• Alberta
• Aldie
• Allison Gap

Browse all communities in Virginia

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

Open CMS sourceHow we calculate rates