CPT code 43246: PEG placement, endoscopic guidance2026 Medicare rate & RVUs in Missouri
Reports endoscopically guided placement of a gastrostomy tube to provide stomach access for patients who cannot maintain adequate oral intake.
CMS doesn’t publish an office rate for 43246 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 43246 covers
A physician uses an upper gastrointestinal endoscope to guide placement of a feeding tube through the abdominal wall into the stomach. This percutaneous endoscopic gastrostomy (PEG) is commonly performed for patients with dysphagia or other conditions that prevent adequate oral nutrition, including some patients with neurologic disease or head and neck cancer. The service is typically performed in a hospital or endoscopy setting by a gastroenterologist or surgeon.
Report 43246 when the endoscopic service includes placement of the gastrostomy tube; a routine diagnostic examination used to guide placement is not a separate diagnostic EGD. Document the indication, endoscopic guidance, and completed tube placement. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons are permitted, while team surgery is 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 43246 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $175.22 |
| Metropolitan St. Louis, MO | Unavailable | $176.25 |
| Rest of Missouri | Unavailable | $171.72 |
How the 43246 rate is calculated
Each of 43246’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 · 43246
RVUs × geographic indexes × conversion factor
Work3.47
3.47 RVUs× 1.000 GPCI
Practice expense1.34
1.34 RVUs× 1.000 GPCI
Malpractice0.53
0.53 RVUs× 1.000 GPCI
Adjusted RVUs
5.3400
Conversion factor
$33.4009
Medicare rate
$178.36
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43246
The CMS indicators that decide how 43246 is paid alongside other services.
CMS payment indicators · 43246
PEG placement, endoscopic guidance
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43246 without 51 · national facility
$178.36
PEG placement, endoscopic guidance
43246-51 · Second procedure: 50%
$89.18
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%).
43246 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43241Endoscopic tube placementIntraluminal tube or catheter
- Choose 43246 for endoscopically guided placement of a gastrostomy tube through the abdominal wall. Choose 43241 for insertion of an intraluminal tube or catheter through the upper GI tract.
- 49440Gastrostomy placementPercutaneous, image-guided
- Both establish gastrostomy access, but 43246 uses endoscopic guidance and 49440 uses a radiologic approach.
- 43235Upper GI endoscopyDiagnostic, brushings or washings
- 43235 describes a diagnostic EGD. The examination used to guide gastrostomy tube placement is part of 43246, not a separate diagnostic service by itself.
43246 billing questions
How is 43246 different from 43241?
43246 is for placing a gastrostomy tube through the abdominal wall into the stomach under endoscopic guidance. 43241 describes endoscopic insertion of an intraluminal tube or catheter, such as a tube placed through the natural passage.
Can a diagnostic EGD be reported separately with 43246?
Do not separately report a diagnostic EGD solely for the examination used to guide gastrostomy tube placement. The endoscopic guidance is part of the placement service.
What documentation supports 43246?
Document the clinical need for gastrostomy access, the endoscopic guidance, and that the tube was placed. The record should identify the provider or providers who performed the service.
Does modifier 50 apply if the procedure involves both sides?
No. CMS identifies bilateral adjustment as inappropriate for 43246; modifier 50 is not appropriate for this service.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons are permitted, but team surgery is not.
How does CMS price 43246 with another endoscopy?
When related endoscopies are performed together, CMS applies endoscopy family pricing. The code has a 0-day global period, which includes same-day preoperative and postoperative care.
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
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