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CPT code 43253: EUS-guided procedure, transmural injection or marking2026 Medicare rate & RVUs

Report this service when an endoscopist uses endoscopic ultrasound to guide an injection or marker placement through the gastrointestinal wall.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.9K Medicare services in 2024

Medicare pays $230.13 for 43253 nationally in a facility.

Medicare rate · 43253

EUS-guided procedure, transmural injection or marking

Office or facility?

Work RVUs
4.61
Total RVUs
6.89
Global days
000

National rate · 2026

$230.13

Facility setting, before claim adjustments.

See every locality for 43253 →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 43253 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 43253 covers

An upper endoscopist uses an endoscope with ultrasound imaging to guide a needle through the gastrointestinal wall to inject a substance or place a marker. Typical uses include injecting around the celiac plexus to address pancreatic cancer pain and placing fiducial markers near a lesion to guide radiation treatment. The procedure is generally performed by a gastroenterologist in a hospital or ambulatory endoscopy setting.

Choose this code when the EUS-guided service is injection or marking, rather than tissue sampling or diagnostic imaging alone. The report should identify the target, purpose, and substance or marker used. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay for an assistant at surgery; 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 43253 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

43253 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$215.45
AlaskaUnavailable$303.49
ArizonaUnavailable$225.88
ArkansasUnavailable$213.65
Atlanta, GAUnavailable$234.90
Austin, TXUnavailable$231.98
Bakersfield, CAUnavailable$232.24
Baltimore area, MDUnavailable$240.89
Beaumont, TXUnavailable$223.60
Brazoria, TXUnavailable$227.15

43253 rates by state

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

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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
43253 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 43253 rate is calculated

Each of 43253’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 · 43253

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

Malpractice0.50

0.50 RVUs× 1.000 GPCI

Adjusted RVUs

6.8900

Conversion factor

$33.4009

Medicare rate

$230.13

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

Payment rules and modifiers for 43253

The CMS indicators that decide how 43253 is paid alongside other services.

CMS payment indicators · 43253

EUS-guided procedure, transmural injection or marking

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

43253 without 51 · national facility

$230.13

EUS-guided procedure, transmural injection or marking

43253-51 · Second procedure: 50%

$115.07

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

43253 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 43253

    EUS-guided procedure, transmural injection or marking4.61 wRVU

    Not priced

  • 43242

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

    Not priced

  • 43259

    Endoscopic ultrasound, diagnostic examination3.94 wRVU

    Not priced

  • 43240

    Pseudocyst drainage, transmural, endoscopic6.97 wRVU

    Not priced

  • 43266

    Endoscopic stent, upper GI tract3.82 wRVU

    Not priced

How to choose

43242EUS-guided biopsyIntramural or transmural sampling
43242 is for EUS-guided fine-needle sampling. Choose 43253 when the needle delivers an injection or places a marker instead of obtaining a specimen.
43259Endoscopic ultrasoundDiagnostic examination
43259 represents an EUS examination. Choose 43253 when the documented service includes EUS-guided injection or marking.
43240Pseudocyst drainageTransmural, endoscopic
43240 is used for transmural drainage of a cyst. It is not the code for EUS-guided injection or marker placement.
43266Endoscopic stentUpper GI tract
43266 covers endoscopic stent placement. Choose 43253 for EUS-guided injection or marking, not stent deployment.

Codes related to 43253

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

Codes related to 43253
CodeHow it relatesNational office range
Same family
43242EUS-guided biopsy, intramural or transmural samplingEUS-guided tissue sampling, rather than injection or marker placement.No office rate
43259Endoscopic ultrasound, diagnostic examinationEUS examination without the injection or marking service described here.No office rate
43240Pseudocyst drainage, transmural, endoscopicUpper endoscopic transmural cyst drainage, a distinct therapeutic intervention.No office rate
43266Endoscopic stent, upper GI tractUpper endoscopic stent placement, rather than EUS-guided injection or marking.No office rate

43253 billing questions

How does this differ from EUS-guided biopsy or aspiration?

Use 43253 for EUS-guided injection or marker placement. Use 43242 when the EUS-guided service obtains tissue or fluid for sampling.

Can diagnostic EUS be reported instead?

43259 describes an EUS examination. When the documented service includes EUS-guided injection or marking, 43253 represents that therapeutic action rather than diagnostic imaging alone.

What documentation supports this code?

Document the EUS guidance, the target and route, the clinical purpose, and what was injected or placed. For example, identify celiac plexus injection or fiducial marker placement when performed.

Should modifier 50 be appended?

No. CMS identifies bilateral adjustment as inappropriate for this service.

How are other endoscopies in the same session priced?

CMS endoscopy family pricing applies when related endoscopies are performed together, so they are not priced as unrelated procedures.

Can an assistant or co-surgeon be paid?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

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 43253PPRRVU2026_Oct_nonQPP.csv, line 5,182 (RVU26D)

Open CMS sourceHow we calculate rates

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