CPT 43198: Esophageal biopsyMedicare rate & RVUs
Reports flexible transnasal esophagoscopy with biopsy when a physician samples esophageal tissue to evaluate suspected mucosal disease or an abnormality.
Medicare pays $218.11 for 43198 nationally in the office and $81.83 in a hospital or facility. Local office rates run $192.82–$287.32.
Medicare rate · 43198
Esophageal biopsy
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- Work RVUs
- 1.77
- Total RVUs
- 6.53
- Global days
- 000
National rate · 2026
$218.11
Office setting, before claim adjustments.
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
What 43198 covers
The physician advances a flexible endoscope through the nose into the esophagus and obtains tissue samples for examination. Otolaryngologists and other physicians trained in transnasal esophagoscopy may perform this service in an office or facility setting. It can be used to investigate symptoms such as dysphagia or to assess a visible or suspected esophageal abnormality when tissue diagnosis is needed.
Report 43198 for the transnasal flexible approach when biopsy is performed; the code includes single or multiple biopsies during the session. The procedure note should establish the route, esophageal findings, biopsy sites, and that tissue was obtained. 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 for this service. Medicare does not pay an assistant at surgery for it, 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 43198 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$192.82 to $287.32
109 of 109 payment localities
43198 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.
$192.82
$258.51
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $253.71 | 1 |
| AL | $195.65 | 1 |
| AR | $192.82 | 1 |
| AZ | $212.24 | 1 |
| CA | $229.70–$287.32 | 29 |
| CO | $226.63 | 1 |
| CT | $232.64 | 1 |
| DC | $249.06 | 1 |
| DE | $215.75 | 1 |
| FL | $215.68–$237.05 | 3 |
| GA | $203.44–$222.37 | 2 |
| GU | $235.23 | 1 |
| HI | $235.23 | 1 |
| IA | $200.27 | 1 |
| ID | $201.66 | 1 |
| IL | $209.70–$230.09 | 4 |
| IN | $202.82 | 1 |
| KS | $199.50 | 1 |
| KY | $200.68 | 1 |
| LA | $200.43–$210.36 | 2 |
| MA | $225.34–$248.84 | 2 |
| MD | $219.82–$249.06 | 3 |
| ME | $202.90–$213.67 | 2 |
| MI | $206.08–$218.56 | 2 |
| MN | $216.60 | 1 |
| MO | $197.10–$210.89 | 3 |
| MS | $194.99 | 1 |
| MT | $218.09 | 1 |
| NC | $205.00 | 1 |
| ND | $213.15 | 1 |
| NE | $201.31 | 1 |
| NH | $223.24 | 1 |
| NJ | $235.14–$246.50 | 2 |
| NM | $207.28 | 1 |
| NV | $216.86 | 1 |
| NY | $208.10–$257.52 | 5 |
| OH | $205.07 | 1 |
| OK | $200.13 | 1 |
| OR | $215.03–$233.64 | 2 |
| PA | $205.30–$226.96 | 2 |
| PR | $219.64 | 1 |
| RI | $223.30 | 1 |
| SC | $205.41 | 1 |
| SD | $212.56 | 1 |
| TN | $200.53 | 1 |
| TX | $203.96–$226.01 | 8 |
| UT | $208.22 | 1 |
| VA | $213.09–$249.06 | 2 |
| VI | $219.64 | 1 |
| VT | $212.48 | 1 |
| WA | $224.86–$253.73 | 2 |
| WI | $206.00 | 1 |
| WV | $201.97 | 1 |
| WY | $215.94 | 1 |
How the 43198 rate is calculated
Each of 43198’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 · 43198
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.77Practice expense 4.51Malpractice 0.25
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43198
The CMS indicators that decide how 43198 is paid alongside other services.
CMS payment indicators · 43198
Esophageal biopsy
| 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
43198 without 51 · national office
$218.11
Esophageal biopsy
43198-51 · Second procedure: 50%
$109.06
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%).
43198 compared with similar codes
Compare codes
43198 vs 43197 vs 43193 vs 43202: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43197Esophagoscopy
- Choose 43198 when tissue is obtained by biopsy during flexible transnasal esophagoscopy. Choose 43197 for the transnasal diagnostic examination with brushing or washing collection.
- 43193Esophagoscopy
- Both involve esophageal biopsy, but 43193 uses a rigid instrument passed transorally; 43198 uses a flexible instrument passed transnasally.
- 43202Esophageal biopsy
- Both report flexible esophagoscopy with biopsy. Use 43198 for the transnasal route and 43202 for the transoral route.
43198 billing questions
How does 43198 differ from 43197?
43198 reports tissue biopsy during flexible transnasal esophagoscopy. 43197 is the transnasal flexible diagnostic service with specimen collection by brushing or washing.
Can multiple biopsy samples be billed as multiple units?
No. The code covers a single or multiple biopsies during the procedure; document the sampled sites and findings, but do not count each specimen as a separate unit of 43198.
How does 43198 differ from 43202?
Both include esophageal biopsy, but 43198 uses a transnasal approach and 43202 uses a transoral flexible approach. The documented route identifies the appropriate code.
Should modifier 50 be reported?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this esophageal procedure.
What happens when another related endoscopy is performed at the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. The procedure record should identify each service performed.
Is an assistant or co-surgeon payable?
Medicare does not pay an assistant at surgery for 43198. 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
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