CPT code 43253: EUS-guided procedure, transmural injection or marking2026 Medicare rate & RVUs in Florida
Report this service when an endoscopist uses endoscopic ultrasound to guide an injection or marker placement through the gastrointestinal wall.
CMS doesn’t publish an office rate for 43253 in Florida.
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 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 in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | Unavailable | $244.40 |
| Miami, FL | Unavailable | $258.10 |
| Rest of Florida | Unavailable | $235.92 |
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
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
| 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not 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
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%).
43253 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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