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Billing code 43246: PEG placementMedicare rate & RVUs

Reports endoscopically guided placement of a gastrostomy tube to provide stomach access for patients who cannot maintain adequate oral intake.

CMS RVU26DEffective Oct 1, 2026109 payment localities46.6K Medicare services in 2024

Medicare pays $178.36 for 43246 nationally in a facility.

Medicare rate · 43246

PEG placement

Swap in your local Medicare rate.

Work RVUs
3.47
Total RVUs
5.34
Global days
000

National rate · 2026

$178.36

Facility setting, before claim adjustments.

See every locality for 43246 → · 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 43246 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 43246 covers

A physician uses an upper gastrointestinal endoscope to guide placement of a feeding tube through the abdominal wall into the stomach. This percutaneous endoscopic gastrostomy (PEG) is commonly performed for patients with dysphagia or other conditions that prevent adequate oral nutrition, including some patients with neurologic disease or head and neck cancer. The service is typically performed in a hospital or endoscopy setting by a gastroenterologist or surgeon.

Report 43246 when the endoscopic service includes placement of the gastrostomy tube; a routine diagnostic examination used to guide placement is not a separate diagnostic EGD. Document the indication, endoscopic guidance, and completed tube placement. CMS assigns 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 for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons are permitted, while team surgery is 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 43246 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

43246 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$165.08
Alaska*Unavailable$231.27
ArizonaUnavailable$174.42
ArkansasUnavailable$163.46
AtlantaUnavailable$182.98
AustinUnavailable$179.17
BakersfieldUnavailable$177.94
Baltimore/Surr. CntysUnavailable$187.68
BeaumontUnavailable$173.08
BrazoriaUnavailable$174.99

43246 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
43246 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 43246 rate is calculated

Each of 43246’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 · 43246

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 3.47Practice expense 1.34Malpractice 0.53

5.3400 adjusted RVUs×$33.4009 conversion factor=$178.36

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

Payment rules and modifiers for 43246

The CMS indicators that decide how 43246 is paid alongside other services.

CMS payment indicators · 43246

PEG placement

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)0Not paid without supporting documentation.
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

43246 without 51 · national facility

$178.36

PEG placement

43246-51 · Second procedure: 50%

$89.18

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

43246 compared with similar codes

Compare codes

43246 vs 43241 vs 49440 vs 43235: national Medicare rates

Swap in your local Medicare rate.

  • 43246
    PEG placement · 3.47 wRVU
    —
  • 43241
    Endoscopic tube placement · 2.43 wRVU
    —
  • 49440
    Gastrostomy placement · 3.83 wRVU
    $788.26
  • 43235
    Upper GI endoscopy · 2.04 wRVU
    $322.65

How to choose

43241Endoscopic tube placement
Choose 43246 for endoscopically guided placement of a gastrostomy tube through the abdominal wall. Choose 43241 for insertion of an intraluminal tube or catheter through the upper GI tract.
49440Gastrostomy placement
Both establish gastrostomy access, but 43246 uses endoscopic guidance and 49440 uses a radiologic approach.
43235Upper GI endoscopy
43235 describes a diagnostic EGD. The examination used to guide gastrostomy tube placement is part of 43246, not a separate diagnostic service by itself.

Codes related to 43246

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

Codes related to 43246
CodeHow it relatesNational office range
Used instead
43241Endoscopic tube placementUsed for endoscopic insertion of an intraluminal tube or catheter rather than gastrostomy placement.No office rate
49440Gastrostomy placementProvides gastrostomy access by a radiologic rather than endoscopic approach.$690.21–$1,081.19
Often billed with
43239EGD with biopsyA separately indicated biopsy may be performed during the same endoscopic session; CMS endoscopy family pricing applies when related.$367.66–$569.97

43246 billing questions

How is 43246 different from 43241?

43246 is for placing a gastrostomy tube through the abdominal wall into the stomach under endoscopic guidance. 43241 describes endoscopic insertion of an intraluminal tube or catheter, such as a tube placed through the natural passage.

Can a diagnostic EGD be reported separately with 43246?

Do not separately report a diagnostic EGD solely for the examination used to guide gastrostomy tube placement. The endoscopic guidance is part of the placement service.

What documentation supports 43246?

Document the clinical need for gastrostomy access, the endoscopic guidance, and that the tube was placed. The record should identify the provider or providers who performed the service.

Does modifier 50 apply if the procedure involves both sides?

No. CMS identifies bilateral adjustment as inappropriate for 43246; modifier 50 is not appropriate for this service.

When is assistant-at-surgery payment allowed?

CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons are permitted, but team surgery is not.

How does CMS price 43246 with another endoscopy?

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

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 43246PPRRVU2026_Oct_nonQPP.csv, line 5,174 (RVU26D)

Open CMS sourceHow we calculate rates

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