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

In Indiana, Medicare pays $217.05 for 43242 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43242 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 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.

How Indiana compares for 43242

Across 109 of 109 payment localities, the facility rate for 43242 runs from $213.48 in Arkansas to $303.30 in Alaska. Indiana pays $217.05. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43242 rates by state

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

See 43242 in every payment locality

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.

Payment rules and modifiers for 43242

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

What modifiers do to the payment

When to use modifier 51

Codes related to 43242

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

How 43242 has changed in Indiana

Price 43242 for an earlier date of service

Where the Indiana rate applies

Indiana is a Medicare payment area, not a city. Our Census mapping connects it to 974 cities and communities in Indiana. Some span more than one payment area; confirm with the service ZIP.

• Aberdeen
• Abington
• Adams
• Adams Lake
• Advance
• Akron
• Alamo
• Albany

Browse all communities in Indiana

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