Billing code 43202: Esophageal biopsyMedicare rate & RVUs
Flexible esophagoscopy with forceps sampling of esophageal tissue is reported when examination is confined to the esophagus and tissue diagnosis is needed.
Medicare pays $393.13 for 43202 nationally in the office and $93.19 in a hospital or facility. Local office rates run $343.20–$541.91.
Medicare rate · 43202
Esophageal biopsy
- Work RVUs
- 1.68
- Total RVUs
- 11.77
- Global days
- 000
National rate · 2026
$393.13
Office setting, before claim adjustments.
See every locality for 43202 →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
What 43202 covers
A flexible scope is passed through the mouth to inspect the esophagus, and tissue is collected for examination, typically with biopsy forceps. Gastroenterologists and other physicians trained in endoscopy may perform it in an office or an endoscopy facility. Common reasons include sampling an abnormal esophageal area, such as inflamed or suspicious mucosa. The service includes one or multiple biopsies during the examination.
Choose this code when the procedure is limited to the esophagus; if the examination extends into the stomach or duodenum, select the applicable upper endoscopy code instead. Document the esophageal findings, biopsy location, and sampling performed. 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 an assistant at surgery for this service, and co-surgeon and team-surgery billing 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 43202 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
$343.20 to $541.91
109 of 109 payment localities
43202 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.
$343.20
$482.21
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 | $439.49 | 1 |
| AL | $348.83 | 1 |
| AR | $343.20 | 1 |
| AZ | $381.89 | 1 |
| CA | $422.51–$541.91 | 29 |
| CO | $413.39 | 1 |
| CT | $421.13 | 1 |
| DC | $455.69 | 1 |
| DE | $388.74 | 1 |
| FL | $382.14–$417.38 | 3 |
| GA | $358.84–$399.99 | 2 |
| GU | $435.39 | 1 |
| HI | $435.39 | 1 |
| IA | $360.85 | 1 |
| ID | $363.03 | 1 |
| IL | $368.37–$407.85 | 4 |
| IN | $365.43 | 1 |
| KS | $357.97 | 1 |
| KY | $355.90 | 1 |
| LA | $354.88–$374.61 | 2 |
| MA | $410.09–$458.68 | 2 |
| MD | $397.07–$455.69 | 3 |
| ME | $364.08–$387.57 | 2 |
| MI | $365.32–$386.39 | 2 |
| MN | $397.76 | 1 |
| MO | $347.41–$377.30 | 3 |
| MS | $345.43 | 1 |
| MT | $393.11 | 1 |
| NC | $368.49 | 1 |
| ND | $388.96 | 1 |
| NE | $363.36 | 1 |
| NH | $405.78 | 1 |
| NJ | $426.41–$449.94 | 2 |
| NM | $367.15 | 1 |
| NV | $392.29 | 1 |
| NY | $374.55–$465.10 | 5 |
| OH | $364.47 | 1 |
| OK | $356.25 | 1 |
| OR | $389.73–$428.86 | 2 |
| PA | $365.68–$409.02 | 2 |
| PR | $396.65 | 1 |
| RI | $404.33 | 1 |
| SC | $367.00 | 1 |
| SD | $388.47 | 1 |
| TN | $359.85 | 1 |
| TX | $362.93–$411.58 | 8 |
| UT | $372.61 | 1 |
| VA | $385.46–$455.69 | 2 |
| VI | $396.65 | 1 |
| VT | $386.36 | 1 |
| WA | $409.67–$469.56 | 2 |
| WI | $374.41 | 1 |
| WV | $352.92 | 1 |
| WY | $391.30 | 1 |
How the 43202 rate is calculated
Each of 43202’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 · 43202
RVUs × geographic indexes × conversion factor
Work1.68
1.68 RVUs× 1.000 GPCI
Practice expense9.88
9.88 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
11.7700
Conversion factor
$33.4009
Medicare rate
$393.13
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43202
The CMS indicators that decide how 43202 is paid alongside other services.
CMS payment indicators · 43202
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
43202 without 51 · national office
$393.13
Esophageal biopsy
43202-51 · Second procedure: 50%
$196.57
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%).
43202 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43200Esophagoscopy
- Choose 43202 for forceps tissue sampling. Choose 43200 when the esophageal specimen is collected by brushing for cytology.
- 43232Esophageal EUS
- 43202 samples accessible esophageal mucosa with routine biopsy technique; 43232 uses endoscopic ultrasound guidance for needle sampling.
- 43235Upper GI endoscopy
- 43202 is limited to esophagoscopy with tissue biopsy. 43235 is an upper endoscopy service when the examination includes the stomach or duodenum.
- 43211Esophageal resection
- 43202 takes tissue samples for diagnosis. 43211 removes esophageal mucosa as a therapeutic resection rather than performing a routine biopsy.
43202 billing questions
How is this different from code 43200?
Code 43202 involves tissue biopsy, generally collected with forceps. Code 43200 describes esophageal brushing for cytology rather than forceps tissue sampling.
Can a separate biopsy code be reported for the same esophageal samples?
The biopsy is included in this service. Do not separately report another biopsy service for the same sampling.
When should an EGD code be selected instead?
Use an applicable EGD code when the examination includes the stomach or duodenum. This code is for examination and biopsy confined to the esophagus.
How does CMS price related endoscopies performed in the same session?
CMS applies endoscopy-family pricing when related endoscopies are performed together. The 0-day global period includes same-day preoperative and postoperative care.
Which surgical modifiers are appropriate?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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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