CPT code 43246: PEG placement, endoscopic guidance2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $178.59 for 43246 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43246 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 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.

How Puerto Rico compares for 43246

Across 109 of 109 payment localities, the facility rate for 43246 runs from $163.46 in Arkansas to $231.27 in Alaska. Puerto Rico pays $178.59. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43246 rates by state

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

See 43246 in every payment locality

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.

Payment rules and modifiers for 43246

The CMS indicators that decide how 43246 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 43246

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

How 43246 has changed in Puerto Rico

Price 43246 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