FeeBase
Log inGet started
Menu

CPT code 43242: EUS-guided biopsy, intramural or transmural sampling2026 Medicare rate & RVUs

Report this service when upper endoscopy with endoscopic ultrasound guides needle aspiration or biopsy of a lesion in or beyond the gastrointestinal wall.

CMS RVU26DEffective Oct 1, 2026109 payment localities26.4K Medicare services in 2024

Medicare pays $229.80 for 43242 nationally in a facility.

Medicare rate · 43242

EUS-guided biopsy, intramural or transmural sampling

Office or facility?

Work RVUs
4.61
Total RVUs
6.88
Global days
000

National rate · 2026

$229.80

Facility setting, before claim adjustments.

See every locality for 43242 →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 43242 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 43242 covers

A gastroenterologist typically performs this procedure in a hospital endoscopy unit or ambulatory surgery center. The endoscope and ultrasound imaging are used to evaluate the upper gastrointestinal tract and guide a needle into a target within the wall or through it. Targets may include a subepithelial lesion, a pancreatic mass, or an adjacent lymph node. The service includes the EUS examination of the esophagus, stomach, and either the duodenum or jejunum as appropriate.

Select this code when the documented service includes EUS-guided intramural or transmural needle aspiration or biopsy; a diagnostic EUS without needle sampling is a different service. Document the target, the EUS-guided needle sampling performed, and the examination extent. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS applies endoscopy-family pricing. Modifier 50 is not appropriate for this procedure. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery 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 43242 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

43242 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$215.26
AlaskaUnavailable$303.30
ArizonaUnavailable$225.60
ArkansasUnavailable$213.48
Atlanta, GAUnavailable$234.50
Austin, TXUnavailable$231.69
Bakersfield, CAUnavailable$232.03
Baltimore area, MDUnavailable$240.48
Beaumont, TXUnavailable$223.29
Brazoria, TXUnavailable$226.89

43242 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
43242 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 43242 rate is calculated

Each of 43242’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 · 43242

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.61

4.61 RVUs× 1.000 GPCI

Practice expense1.78

1.78 RVUs× 1.000 GPCI

Malpractice0.49

0.49 RVUs× 1.000 GPCI

Adjusted RVUs

6.8800

Conversion factor

$33.4009

Medicare rate

$229.80

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

Payment rules and modifiers for 43242

The CMS indicators that decide how 43242 is paid alongside other services.

CMS payment indicators · 43242

EUS-guided biopsy, intramural or transmural sampling

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

43242 without 51 · national facility

$229.80

EUS-guided biopsy, intramural or transmural sampling

43242-51 · Second procedure: 50%

$114.90

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

43242 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 43242

    EUS-guided biopsy, intramural or transmural sampling4.61 wRVU

    Not priced

  • 43238

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

    Not priced

  • 43237

    Endoscopic ultrasound, limited upper GI examination3.38 wRVU

    Not priced

  • 43239

    EGD with biopsy, single or multiple biopsies2.33 wRVU

    $418.85

  • 43232

    Esophageal EUS, EUS-guided needle sampling3.5 wRVU

    Not priced

How to choose

43238EUS-guided biopsyLimited upper GI examination
Both involve EUS-guided needle sampling. Distinguish 43242's intramural or transmural sampling service and included examination from 43238's transmural sampling criteria.
43237Endoscopic ultrasoundLimited upper GI examination
43237 describes diagnostic EUS without needle sampling; 43242 requires EUS-guided aspiration or biopsy.
43239EGD with biopsySingle or multiple biopsies
43239 is for upper endoscopic mucosal biopsy, typically with forceps. 43242 uses EUS guidance to direct a needle into a target within or beyond the wall.
43232Esophageal EUSEUS-guided needle sampling
43232 uses an esophagoscopic approach for EUS-guided needle biopsy. Use 43242 when the documented service is the broader upper endoscopic examination and sampling service.

Codes related to 43242

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

Codes related to 43242
CodeHow it relatesNational office range
Same family
43238EUS-guided biopsy, limited upper GI examinationRelated EUS-guided needle sampling service distinguished by its transmural sampling criteria.No office rate
Used instead
43237Endoscopic ultrasound, limited upper GI examinationDiagnostic EUS examination without the needle sampling reported with 43242.No office rate
43239EGD with biopsy, single or multiple biopsiesUpper endoscopic mucosal biopsy uses a different sampling method from EUS-guided needle acquisition.$367.66–$569.97
43232Esophageal EUS, EUS-guided needle samplingEUS-guided needle biopsy by esophagoscopy is limited to the esophageal approach.No office rate

43242 billing questions

How does 43242 differ from 43238?

43242 covers needle sampling of an intramural or transmural target and includes the specified EUS examination. Use 43238 for the transmural sampling service when that code's criteria are met.

Can 43242 be reported for diagnostic EUS without needle sampling?

No. When the EUS examination is performed without needle aspiration or biopsy, consider the diagnostic EUS code that matches the examination extent, such as 43237.

Is a mucosal forceps biopsy included in 43242?

43242 describes EUS-guided needle sampling, not routine mucosal forceps biopsy. Code 43239 represents upper endoscopic mucosal biopsy when its service is performed and separately reportable.

What documentation supports reporting 43242?

Document the EUS examination, the target's location, and the needle aspiration or biopsy performed under ultrasound guidance. The record should support sampling within the wall or through it.

Can modifier 50 be appended when sampling targets on both sides?

No. Modifier 50 is inappropriate for this upper gastrointestinal endoscopic service.

How does Medicare treat related endoscopies performed together?

CMS applies endoscopy-family pricing when related endoscopies are performed together. Same-day preoperative and postoperative care is included in the 0-day global period.

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 43242PPRRVU2026_Oct_nonQPP.csv, line 5,170 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 43242 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 43242 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Build my fee sheet