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Billing code 43192: EsophagoscopyMedicare rate & RVUs

Reports rigid transoral esophagoscopy with therapeutic injection, such as targeted botulinum toxin treatment for upper esophageal sphincter dysfunction.

CMS RVU26DEffective Oct 1, 2026109 payment localities252 Medicare services in 2024

Medicare pays $146.96 for 43192 nationally in a facility.

Medicare rate · 43192

Esophagoscopy

Swap in your local Medicare rate.

Work RVUs
2.72
Total RVUs
4.40
Global days
000

National rate · 2026

$146.96

Facility setting, before claim adjustments.

See every locality for 43192 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 43192 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 43192 covers

The physician passes a rigid endoscope through the mouth to examine the esophagus and deliver one or more injections at a targeted site. Otolaryngologists commonly perform this procedure in an operating room, including for selected patients with cricopharyngeal or upper esophageal sphincter dysfunction receiving botulinum toxin. The operative report should identify the scope approach, injection site, agent, and therapeutic purpose.

Report this code when injection is performed during rigid transoral esophagoscopy; a diagnostic examination alone, tissue sampling, foreign-body removal, or dilation represents a different service. The injection code covers the injection work during the procedure, so do not assign additional units solely for multiple injection sites in the same session. CMS assigns a 0-day global period, including same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate; assistant-at-surgery payment is statutorily restricted, and 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 43192 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

43192 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$135.82
Alaska*Unavailable$189.17
ArizonaUnavailable$143.71
ArkansasUnavailable$134.46
AtlantaUnavailable$150.61
AustinUnavailable$148.10
BakersfieldUnavailable$147.57
Baltimore/Surr. CntysUnavailable$154.70
BeaumontUnavailable$142.17
BrazoriaUnavailable$144.37

43192 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
43192 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 43192 rate is calculated

Each of 43192’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 · 43192

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 2.72Practice expense 1.28Malpractice 0.40

4.4000 adjusted RVUs×$33.4009 conversion factor=$146.96

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 43192

The CMS indicators that decide how 43192 is paid alongside other services.

CMS payment indicators · 43192

Esophagoscopy

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

43192 without 51 · national facility

$146.96

Esophagoscopy

43192-51 · Second procedure: 50%

$73.48

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

43192 compared with similar codes

Compare codes

43192 vs 43191 vs 43193 vs 43201 vs 43195: national Medicare rates

Swap in your local Medicare rate.

  • 43192
    Esophagoscopy · 2.72 wRVU
    —
  • 43191
    Esophagoscopy · 2.43 wRVU
    —
  • 43193
    Esophagoscopy · 2.72 wRVU
    —
  • 43201
    Esophagoscopy · 1.68 wRVU
    $278.23
  • 43195
    Esophageal dilation · 2.99 wRVU
    —

How to choose

43191Esophagoscopy
Choose 43191 for rigid transoral diagnostic examination without injection. Choose 43192 when injection is performed during that examination.
43193Esophagoscopy
43193 reports biopsy during rigid transoral esophagoscopy; 43192 reports injection. The operative note should support which intervention occurred.
43201Esophagoscopy
Both involve injection during esophagoscopy, but 43201 uses a flexible transoral scope and 43192 uses a rigid transoral scope.
43195Esophageal dilation
43195 is for balloon dilation during rigid transoral esophagoscopy. It is not the injection code.

Codes related to 43192

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

Codes related to 43192
CodeHow it relatesNational office range
Same family
43191EsophagoscopyRigid transoral diagnostic esophagoscopy without the injection service.No office rate
43193EsophagoscopyRigid transoral esophagoscopy with biopsy rather than injection.No office rate
43195Esophageal dilationRigid transoral esophagoscopy with balloon dilation.No office rate
43196Esophageal dilationRigid transoral esophagoscopy with guidewire-assisted dilation.No office rate
Used instead
43201EsophagoscopyInjection during flexible rather than rigid transoral esophagoscopy.$244.38–$375.92

43192 billing questions

How does this differ from 43191?

43191 describes rigid transoral esophagoscopy for diagnostic examination. Use 43192 when the physician performs injection during the rigid examination.

How does this differ from 43193?

43193 is the rigid transoral esophagoscopy code for biopsy. Injection is the distinguishing service for 43192; report the procedure actually documented.

Can multiple injection sites be billed as multiple units?

The code includes injection or injections performed during the rigid esophagoscopy. Do not increase units solely because the physician injects more than one site in the same procedure.

Is 43201 interchangeable with this code?

No. 43201 describes injection during flexible transoral esophagoscopy; 43192 is for the rigid transoral approach.

What should the operative note document?

Document the rigid transoral approach, the site and purpose of the injection, and the agent administered. The code has a 0-day global period, and modifier 50 is inappropriate.

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 43192PPRRVU2026_Oct_nonQPP.csv, line 5,133 (RVU26D)

Open CMS sourceHow we calculate rates

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