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

In Puerto Rico, Medicare pays $342.54 for 43240 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43240 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 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.

How Puerto Rico compares for 43240

Across 109 of 109 payment localities, the facility rate for 43240 runs from $317.55 in Arkansas to $451.96 in Alaska. Puerto Rico pays $342.54. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43240 rates by state

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

See 43240 in every payment locality

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

Codes related to 43240

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

How 43240 has changed in Puerto Rico

Price 43240 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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