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CPT code 43259: Endoscopic ultrasound, diagnostic examination2026 Medicare rate & RVUs

Reports upper gastrointestinal endoscopic ultrasound to assess the digestive tract wall and nearby structures, such as the pancreas, bile ducts, and lymph nodes.

CMS RVU26DEffective Oct 1, 2026109 payment localities32.6K Medicare services in 2024

Medicare pays $198.74 for 43259 nationally in a facility.

Medicare rate · 43259

Endoscopic ultrasound, diagnostic examination

Office or facility?

Work RVUs
3.94
Total RVUs
5.95
Global days
000

National rate · 2026

$198.74

Facility setting, before claim adjustments.

See every locality for 43259 →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 43259 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 43259 covers

A gastroenterologist or other qualified endoscopist uses an ultrasound-equipped endoscope to examine the upper digestive tract and structures next to it. Typical indications include characterizing a subepithelial mass, evaluating a pancreatic lesion or cyst, assessing bile duct abnormalities, and staging nearby lymph nodes. The examination may cover the esophagus, stomach, and duodenum or jejunum as clinically appropriate, in a hospital outpatient department or endoscopy center.

Report 43259 for the diagnostic ultrasound examination without the separately coded EUS-guided tissue sampling or therapeutic maneuver. Document the indication, areas examined, ultrasound findings, and any sampling or intervention performed; when tissue is obtained under EUS guidance, consider the applicable sampling code, such as 43238. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies occur together, endoscopy-family pricing applies. Modifier 50 is inappropriate because the examination follows upper-GI anatomy rather than paired sides. Medicare payment is restricted for an assistant at surgery; co-surgeon and team-surgery reporting 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 43259 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

43259 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$185.91
AlaskaUnavailable$261.52
ArizonaUnavailable$195.03
ArkansasUnavailable$184.33
Atlanta, GAUnavailable$202.86
Austin, TXUnavailable$200.42
Bakersfield, CAUnavailable$200.69
Baltimore area, MDUnavailable$208.10
Beaumont, TXUnavailable$192.97
Brazoria, TXUnavailable$196.15

43259 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
43259 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 43259 rate is calculated

Each of 43259’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 · 43259

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.94

3.94 RVUs× 1.000 GPCI

Practice expense1.58

1.58 RVUs× 1.000 GPCI

Malpractice0.43

0.43 RVUs× 1.000 GPCI

Adjusted RVUs

5.9500

Conversion factor

$33.4009

Medicare rate

$198.74

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

Payment rules and modifiers for 43259

The CMS indicators that decide how 43259 is paid alongside other services.

CMS payment indicators · 43259

Endoscopic ultrasound, diagnostic examination

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

43259 without 51 · national facility

$198.74

Endoscopic ultrasound, diagnostic examination

43259-51 · Second procedure: 50%

$99.37

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

43259 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43259

    Endoscopic ultrasound, diagnostic examination3.94 wRVU

    Not priced

  • 43238

    EUS-guided biopsy, limited upper GI examination4.06 wRVU

    Not priced

  • 43253

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

    Not priced

  • 43260

    ERCP, brushing or washing5.7 wRVU

    Not priced

How to choose

43238EUS-guided biopsyLimited upper GI examination
Choose 43259 for diagnostic EUS without tissue acquisition. Choose 43238 when EUS-guided fine-needle sampling is performed.
43253EUS-guided procedureTransmural injection or marking
43259 reports diagnostic ultrasound examination; 43253 describes an EUS-guided transmural injection or marking procedure.
43260ERCPBrushing or washing
43259 uses ultrasound imaging of the upper-GI tract and adjacent structures. 43260 is an ERCP service involving endoscopic access to the biliary or pancreatic ducts.

Codes related to 43259

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

Codes related to 43259
CodeHow it relatesNational office range
Used instead
43238EUS-guided biopsy, limited upper GI examinationUse for EUS-guided tissue sampling; the ultrasound examination is included in that service.No office rate
43253EUS-guided procedure, transmural injection or markingDescribes an EUS-guided transmural injection or marking maneuver rather than diagnostic examination alone.No office rate
43260ERCP, brushing or washingERCP evaluates or treats the biliary and pancreatic ducts through ductal access rather than ultrasound imaging.No office rate

43259 billing questions

When should 43259 be reported instead of 43238?

Use 43259 for diagnostic EUS without needle sampling. When EUS-guided tissue sampling is performed, 43238 describes the sampling service and includes the ultrasound examination.

Can a separate EGD service be billed with 43259?

The examination is performed endoscopically, and related endoscopies performed together are subject to endoscopy-family pricing. Document each service performed and follow the applicable family code selection.

Is modifier 50 appropriate for 43259?

No. The upper-GI examination follows digestive tract anatomy, not paired right and left sides.

What documentation supports 43259?

Record the clinical indication, anatomic regions examined, and ultrasound findings. Clearly identify any EUS-guided tissue sampling or therapeutic maneuver because it may require a different code.

Can an assistant, co-surgeon, or surgical team be reported?

Medicare payment is restricted for an assistant at surgery for this service. Co-surgeon and team-surgery reporting 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 43259PPRRVU2026_Oct_nonQPP.csv, line 5,186 (RVU26D)

Open CMS sourceHow we calculate rates

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