CPT code 43240: Pseudocyst drainage, transmural, endoscopic2026 Medicare rate & RVUs

Medicare pays $342.03 for 43240 nationally in a facility.

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

What 43240 covers

A gastroenterologist typically performs this procedure in a hospital or other facility for a pancreatic pseudocyst or similar collection that can be reached through the stomach or duodenum. Using an upper endoscope, the physician accesses the collection through the gastrointestinal wall and establishes drainage into the digestive tract, often with a stent. Endoscopic ultrasound may be used to locate the collection and guide access; the code covers the drainage service, not just imaging or needle sampling.

Report the code when the physician actually performs transmural drainage, and document the collection, access site, drainage performed, and any device placed. A diagnostic examination or aspiration for sampling alone does not establish that drainage was performed. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing 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.

Where 43240 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

43240 rates by state

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

How the 43240 rate is calculated

Each of 43240’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 43240

The CMS indicators that decide how 43240 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

43240 compared with similar codes

How to choose

43237Endoscopic ultrasoundLimited upper GI examination

43237 describes upper GI endoscopic ultrasound examination. Choose 43240 when the physician also creates a transmural route and drains the collection.

43238EUS-guided biopsyLimited upper GI examination

43238 is for EUS-guided needle sampling. It does not describe therapeutic drainage through the stomach or duodenal wall.

43242EUS-guided biopsyIntramural or transmural sampling

43242 describes EUS-guided fine-needle sampling; 43240 describes drainage of a pseudocyst rather than sampling for diagnosis.

43253EUS-guided procedureTransmural injection or marking

43253 covers EUS-guided transmural injection or marker placement. Use 43240 when the intervention is drainage of a pseudocyst.

Codes related to 43240

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

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