FeeBase
Log inGet started
Menu

Billing code 43232: Esophageal EUSMedicare rate & RVUs

Reports flexible esophagoscopy with ultrasound-guided needle sampling of tissue or a lesion in the esophageal wall or nearby structures.

CMS RVU26DEffective Oct 1, 2026109 payment localities325 Medicare services in 2024

Medicare pays $177.36 for 43232 nationally in a facility.

Medicare rate · 43232

Esophageal EUS

Swap in your local Medicare rate.

Work RVUs
3.5
Total RVUs
5.31
Global days
000

National rate · 2026

$177.36

Facility setting, before claim adjustments.

See every locality for 43232 → · 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 43232 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 43232 covers

A gastroenterologist passes a flexible endoscope through the mouth to examine the esophagus and uses endoscopic ultrasound to guide a needle into tissue for aspiration or biopsy. Typical targets include an esophageal subepithelial lesion or a mediastinal lymph node or mass accessible from the esophagus. The service is generally performed in a procedural endoscopy setting; it is distinct from sampling performed during an examination that continues into the stomach or duodenum.

Report this code when the record supports both esophagoscopy and ultrasound-guided intramural or transmural needle sampling. Document the examination extent, ultrasound findings, target, and needle sampling performed; multiple needle passes are part of the sampling service, not separate units per pass. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate. CMS permits co-surgeons, does not permit team surgery, and does not pay an assistant at surgery.

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 43232 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

43232 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$165.78
Alaska*Unavailable$233.04
ArizonaUnavailable$174.01
ArkansasUnavailable$164.35
AtlantaUnavailable$181.09
AustinUnavailable$178.86
BakersfieldUnavailable$179.04
Baltimore/Surr. CntysUnavailable$185.78
BeaumontUnavailable$172.17
BrazoriaUnavailable$175.00

43232 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
43232 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 43232 rate is calculated

Each of 43232’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 · 43232

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 3.50Practice expense 1.42Malpractice 0.39

5.3100 adjusted RVUs×$33.4009 conversion factor=$177.36

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

Payment rules and modifiers for 43232

The CMS indicators that decide how 43232 is paid alongside other services.

CMS payment indicators · 43232

Esophageal EUS

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)2Permitted.
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

43232 without 51 · national facility

$177.36

Esophageal EUS

43232-51 · Second procedure: 50%

$88.68

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

43232 compared with similar codes

Compare codes

43232 vs 43231 vs 43238 vs 43239: national Medicare rates

Swap in your local Medicare rate.

  • 43232
    Esophageal EUS · 3.5 wRVU
    —
  • 43231
    Esophageal EUS · 2.73 wRVU
    —
  • 43238
    EUS-guided biopsy · 4.06 wRVU
    —
  • 43239
    EGD with biopsy · 2.33 wRVU
    $418.85

How to choose

43231Esophageal EUS
43231 covers esophageal EUS examination without needle sampling. Choose 43232 when the endoscopist also performs ultrasound-guided needle aspiration or biopsy.
43238EUS-guided biopsy
43238 is the EGD-route code for EUS-guided needle sampling. Use 43232 for sampling performed through an esophagoscopy focused on the esophagus.
43239EGD with biopsy
43239 reports EGD with mucosal biopsy. 43232 applies when a needle is guided by endoscopic ultrasound to sample tissue within or beyond the esophageal wall.

Codes related to 43232

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

Codes related to 43232
CodeHow it relatesNational office range
Same family
43231Esophageal EUSEsophagoscopy with EUS examination, without ultrasound-guided needle sampling.No office rate
Used instead
43238EUS-guided biopsyEGD-route EUS-guided needle sampling when the upper endoscopic examination extends beyond the esophagus.No office rate
43237Endoscopic ultrasoundEGD-route EUS examination without needle aspiration or biopsy.No office rate
43239EGD with biopsyEGD mucosal biopsy, rather than EUS-guided needle sampling.$367.66–$569.97

43232 billing questions

When should this be chosen instead of 43231?

Use 43232 when ultrasound-guided needle aspiration or biopsy is performed. 43231 describes esophagoscopy with ultrasound examination without needle sampling.

How does this differ from an EGD with EUS-guided sampling?

43232 describes an esophagoscopy service focused on the esophagus and targets accessible from it. When the endoscopic examination and sampling are performed through an EGD route, consider the applicable EGD sampling code, such as 43238.

Are multiple needle passes reported as separate units?

No. The needle sampling is reported as the procedure, not as a separate unit for each pass. Document the target and sampling performed.

Can modifier 50 be used for bilateral sampling?

No. CMS identifies bilateral adjustment as inappropriate for this code, even when targets are sampled on both sides.

How does CMS handle related endoscopies performed together?

CMS endoscopy family pricing applies when related endoscopies are performed together. The code also has a 0-day global period, which includes same-day preoperative and postoperative care.

Can an assistant or another surgeon be reported?

CMS does not pay an assistant at surgery for this code. Co-surgeons are permitted, while team surgery is 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 43232PPRRVU2026_Oct_nonQPP.csv, line 5,161 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 43232 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 43232 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →