CPT code 43253: EUS-guided procedure, transmural injection or marking2026 Medicare rate & RVUs in Puerto Rico
Report this service when an endoscopist uses endoscopic ultrasound to guide an injection or marker placement through the gastrointestinal wall.
In Puerto Rico, Medicare pays $230.54 for 43253 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 43253 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Puerto Rico compares for 43253
Across 109 of 109 payment localities, the facility rate for 43253 runs from $213.65 in Arkansas to $303.49 in Alaska. Puerto Rico pays $230.54. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$230.54
- Los Angeles, CA · California$241.71+$11.17
- Washington, DC area · District of Columbia$250.92+$20.38
- Miami, FL · Florida$258.10+$27.56
- Chicago, IL · Illinois$253.13+$22.59
- Manhattan, NY · New York$259.40+$28.86
- Alaska · Alaska$303.49+$72.95
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $215.45 |
| ArkansasArkansas | — | $213.65 |
| ArizonaArizona | — | $225.88 |
| Bakersfield, CACalifornia | — | $232.24 |
| Chico, CACalifornia | — | $230.71 |
| El Centro, CACalifornia | — | $230.79 |
| Fresno, CACalifornia | — | $230.71 |
| Hanford, CACalifornia | — | $230.71 |
| Madera, CACalifornia | — | $230.71 |
| Merced, CACalifornia | — | $230.71 |
| Modesto, CACalifornia | — | $230.71 |
| Napa, CACalifornia | — | $250.52 |
| Oxnard, CACalifornia | — | $238.97 |
| Redding, CACalifornia | — | $230.71 |
| Rest of CaliforniaCalifornia | — | $230.71 |
| Riverside, CACalifornia | — | $236.16 |
| Sacramento, CACalifornia | — | $237.62 |
| Salinas, CACalifornia | — | $236.61 |
| San Diego, CACalifornia | — | $238.76 |
| Marin County, CACalifornia | — | $260.10 |
| San Francisco, CACalifornia | — | $259.53 |
| San Benito County, CACalifornia | — | $265.60 |
| Santa Clara County, CACalifornia | — | $263.28 |
| San Luis Obispo, CACalifornia | — | $233.26 |
| Santa Cruz, CACalifornia | — | $238.40 |
| Santa Maria, CACalifornia | — | $236.56 |
| Santa Rosa, CACalifornia | — | $240.56 |
| Stockton, CACalifornia | — | $230.71 |
| Vallejo, CACalifornia | — | $249.70 |
| Visalia, CACalifornia | — | $230.71 |
| Yuba City, CACalifornia | — | $230.71 |
| ColoradoColorado | — | $232.13 |
| ConnecticutConnecticut | — | $241.30 |
| DelawareDelaware | — | $228.50 |
| Fort Lauderdale, FLFlorida | — | $244.40 |
| Rest of FloridaFlorida | — | $235.92 |
| Atlanta, GAGeorgia | — | $234.90 |
| Rest of GeorgiaGeorgia | — | $226.92 |
| Hawaii, Guam, HIHawaii | — | $231.25 |
| IowaIowa | — | $215.01 |
| IdahoIdaho | — | $216.57 |
| East St. Louis, ILIllinois | — | $242.31 |
| Rest of IllinoisIllinois | — | $234.36 |
| Suburban Chicago, ILIllinois | — | $245.71 |
| IndianaIndiana | — | $217.21 |
| KansasKansas | — | $216.14 |
| KentuckyKentucky | — | $222.11 |
| New Orleans, LALouisiana | — | $228.90 |
| Rest of LouisianaLouisiana | — | $222.59 |
| Metropolitan Boston, MAMassachusetts | — | $246.14 |
| Rest of MassachusettsMassachusetts | — | $232.36 |
| Baltimore area, MDMaryland | — | $240.89 |
| Rest of MarylandMaryland | — | $231.02 |
| Rest of MaineMaine | — | $219.06 |
| Southern Maine, MEMaine | — | $223.43 |
| Detroit, MIMichigan | — | $239.51 |
| Rest of MichiganMichigan | — | $227.11 |
| MinnesotaMinnesota | — | $220.10 |
| Metropolitan Kansas City, MOMissouri | — | $226.12 |
| Metropolitan St. Louis, MOMissouri | — | $227.31 |
| Rest of MissouriMissouri | — | $221.49 |
| MississippiMississippi | — | $217.51 |
| MontanaMontana | — | $230.10 |
| North CarolinaNorth Carolina | — | $220.12 |
| North DakotaNorth Dakota | — | $220.21 |
| NebraskaNebraska | — | $215.17 |
| New HampshireNew Hampshire | — | $230.48 |
| Northern New JerseyNew Jersey | — | $250.48 |
| Rest of New JerseyNew Jersey | — | $243.38 |
| New MexicoNew Mexico | — | $228.55 |
| NevadaNevada | — | $227.40 |
| NYC suburbs and Long Island, NYNew York | — | $265.54 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $246.22 |
| Queens, NYNew York | — | $258.19 |
| Rest of New YorkNew York | — | $222.20 |
| OhioOhio | — | $225.09 |
| OklahomaOklahoma | — | $220.05 |
| Portland, OROregon | — | $234.92 |
| Rest of OregonOregon | — | $224.93 |
| Metropolitan Philadelphia, PAPennsylvania | — | $238.56 |
| Rest of PennsylvaniaPennsylvania | — | $224.34 |
| Rhode IslandRhode Island | — | $233.22 |
| South CarolinaSouth Carolina | — | $223.11 |
| South DakotaSouth Dakota | — | $219.04 |
| TennesseeTennessee | — | $216.99 |
| Austin, TXTexas | — | $231.98 |
| Beaumont, TXTexas | — | $223.60 |
| Brazoria, TXTexas | — | $227.15 |
| Dallas, TXTexas | — | $228.91 |
| Fort Worth, TXTexas | — | $228.53 |
| Galveston, TXTexas | — | $228.08 |
| Houston, TXTexas | — | $237.23 |
| Rest of TexasTexas | — | $225.48 |
| UtahUtah | — | $224.86 |
| VirginiaVirginia | — | $224.21 |
| Virgin Islands, VIUnited States Virgin Islands | — | $230.54 |
| VermontVermont | — | $221.29 |
| Rest of WashingtonWashington | — | $231.29 |
| King County, WAWashington | — | $248.27 |
| WisconsinWisconsin | — | $216.08 |
| West VirginiaWest Virginia | — | $229.54 |
| WyomingWyoming | — | $225.79 |
43253 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,182
- Code
- 43253
- Physician work
- 4.61
- Practice expense
- 1.78
- Malpractice
- 0.50
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.61 | × 1.000 | 4.6100 |
| Practice expense | 1.78 | × 1.011 | 1.7996 |
| Malpractice | 0.50 | × 0.985 | 0.4925 |
| Total RVUs | 6.9021 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$230.54
Facility: (4.61 × 1 + 1.78 × 1.011 + 0.5 × 0.985) × $33.4009 = $230.54
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%).
How 43253 has changed in Puerto Rico
43253 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2014
RVU14A
No ratechanged toNo rate
Held through RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D, RVU26A, RVU26B, RVU26C, RVU26D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $230.54 | RVU26D |
| 2026-07-01 | Not available in this setting | $230.54 | RVU26C |
| 2026-04-01 | Not available in this setting | $230.54 | RVU26B |
| 2026-01-01 | Not available in this setting | $230.54 | RVU26A |
| 2025-10-01 | Not available in this setting | $251.24 | RVU25D |
| 2025-07-01 | Not available in this setting | $251.24 | RVU25C |
| 2025-04-01 | Not available in this setting | $251.24 | RVU25B |
| 2025-01-01 | Not available in this setting | $251.24 | RVU25A |
| 2024-10-01 | Not available in this setting | $257.55 | RVU24D |
| 2024-07-01 | Not available in this setting | $257.55 | RVU24C |
| 2024-04-01 | Not available in this setting | $257.55 | RVU24B |
| 2024-03-09 | Not available in this setting | $257.55 | RVU24AR |
| 2024-01-01 | Not available in this setting | $253.35 | RVU24A |
| 2023-10-01 | Not available in this setting | $261.29 | RVU23D |
| 2023-07-01 | Not available in this setting | $260.93 | RVU23C |
| 2023-04-01 | Not available in this setting | $260.93 | RVU23B |
| 2023-01-01 | Not available in this setting | $260.93 | RVU23A |
| 2022-10-01 | Not available in this setting | $266.20 | RVU22D |
| 2022-07-01 | Not available in this setting | $266.20 | RVU22C |
| 2022-04-01 | Not available in this setting | $266.20 | RVU22B |
| 2022-01-01 | Not available in this setting | $266.20 | RVU22A |
| 2021-10-01 | Not available in this setting | $266.67 | RVU21D |
| 2021-07-01 | Not available in this setting | $266.67 | RVU21C |
| 2021-04-01 | Not available in this setting | $266.67 | RVU21B |
| 2021-01-01 | Not available in this setting | $266.67 | RVU21A |
| 2020-10-01 | Not available in this setting | $274.74 | RVU20D |
| 2020-07-01 | Not available in this setting | $274.74 | RVU20C |
| 2020-04-01 | Not available in this setting | $274.74 | RVU20B |
| 2020-01-01 | Not available in this setting | $274.74 | RVU20A |
| 2019-10-01 | Not available in this setting | $277.88 | RVU19D |
| 2019-07-01 | Not available in this setting | $277.88 | RVU19C |
| 2019-04-01 | Not available in this setting | $277.88 | RVU19B |
| 2019-01-01 | Not available in this setting | $277.88 | RVU19A |
| 2018-10-01 | Not available in this setting | $278.67 | RVU18D |
| 2018-07-01 | Not available in this setting | $278.67 | RVU18C |
| 2018-04-01 | Not available in this setting | $278.67 | RVU18B |
| 2018-01-01 | Not available in this setting | $278.67 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $257.38 | RVU17D |
| 2017-07-01 | Not available in this setting | $257.38 | RVU17C |
| 2017-04-01 | Not available in this setting | $257.38 | RVU17B |
| 2017-01-01 | Not available in this setting | $257.38 | RVU17A |
| 2016-10-01 | Not available in this setting | $240.82 | RVU16D |
| 2016-07-01 | Not available in this setting | $240.82 | RVU16C |
| 2016-04-01 | Not available in this setting | $240.82 | RVU16B |
| 2016-01-01 | Not available in this setting | $240.82 | RVU16A |
| 2015-10-01 | Not available in this setting | $244.92 | RVU15D |
| 2015-07-01 | Not available in this setting | $244.92 | RVU15C |
| 2015-04-01 | Not available in this setting | $243.70 | RVU15B |
| 2015-01-01 | Not available in this setting | $243.70 | RVU15A |
| 2014-10-01 | Not available in this setting | $235.54 | RVU14D |
| 2014-07-01 | Not available in this setting | $235.54 | RVU14C |
| 2014-04-01 | Not available in this setting | $235.54 | RVU14B |
| 2014-01-01 | Not available in this setting | $235.54 | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
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
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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