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CPT code 43266: Endoscopic stent2026 Medicare rate & RVUs

Report upper GI endoscopic stent placement when an endoscopist deploys a stent to maintain luminal patency or seal a leak during transoral EGD.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.2K Medicare services in 2024

Medicare pays $192.39 for 43266 nationally in a facility.

Medicare rate · 43266

Endoscopic stent

Work RVUs
3.82
Total RVUs
5.76
Global days
000

National rate · 2026

$192.39

Facility setting, before claim adjustments.

See every locality for 43266 →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 43266 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 43266 covers

During flexible transoral EGD, the endoscopist advances and deploys a stent to maintain patency or seal a leak in the upper gastrointestinal tract. Typical cases include palliation of an obstructing esophageal tumor and endoscopic treatment of a selected luminal narrowing or leak. Gastroenterologists and therapeutic endoscopists perform this service in a hospital or ambulatory endoscopy facility.

Report 43266 for stent deployment; the service includes guidewire passage and pre- or post-dilation when performed. The record should identify the target, indication, stent placement, and any dilation performed. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery, 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 43266 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

43266 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$179.34
Alaska*Unavailable$252.16
ArizonaUnavailable$188.57
ArkansasUnavailable$177.74
AtlantaUnavailable$196.77
AustinUnavailable$193.65
BakersfieldUnavailable$193.23
Baltimore/Surr. CntysUnavailable$201.79
BeaumontUnavailable$186.86
BrazoriaUnavailable$189.44

43266 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
43266 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 43266 rate is calculated

Each of 43266’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 · 43266

RVUs × geographic indexes × conversion factor

Work3.82

3.82 RVUs× 1.000 GPCI

Practice expense1.46

1.46 RVUs× 1.000 GPCI

Malpractice0.48

0.48 RVUs× 1.000 GPCI

Adjusted RVUs

5.7600

Conversion factor

$33.4009

Medicare rate

$192.39

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 43266

The CMS indicators that decide how 43266 is paid alongside other services.

CMS payment indicators · 43266

Endoscopic stent

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

43266 without 51 · national facility

$192.39

Endoscopic stent

43266-51 · Second procedure: 50%

$96.20

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

43266 compared with similar codes

Compare codes · National

4 codes, side by side

  • 43266

    Endoscopic stent3.82 wRVU

    Not priced

  • 43248

    Esophageal dilation2.84 wRVU

    $457.93

  • 43249

    Esophageal dilation2.6 wRVU

    $1,180.39

  • 43274

    ERCP stenting8.27 wRVU

    Not priced

How to choose

43248Esophageal dilation
43248 is used for guidewire-assisted esophageal dilation without endoscopic stent deployment. Dilation performed as part of 43266 is included in that service.
43249Esophageal dilation
43249 describes balloon dilation of the esophagus, not placement of an endoscopic stent. Choose 43266 when a stent is deployed.
43274ERCP stenting
43274 is an ERCP service for stent placement in a bile or pancreatic duct; 43266 is for stent placement during transoral EGD.

Codes related to 43266

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

Codes related to 43266
CodeHow it relatesNational office range
Used instead
43248Esophageal dilationGuidewire-assisted esophageal dilation may be used for narrowing treated without stent placement.$402.83–$618.55
43249Esophageal dilationBalloon dilation is an alternative approach for selected esophageal narrowings.$1,022.75–$1,664.21
43274ERCP stentingPlaces a stent in a bile or pancreatic duct through ERCP rather than transoral EGD.No office rate

43266 billing questions

Is dilation separately reported when it is performed to place the stent?

Pre- and post-dilation, along with guidewire passage when performed, are included in 43266. Do not separately report those steps as stand-alone services.

How is 43266 different from ERCP stent placement?

43266 describes stent placement during transoral EGD in the upper GI tract. Use the ERCP stent code when the stent is placed in a bile or pancreatic duct through ERCP.

What happens when another related endoscopy is performed in the same session?

CMS endoscopy-family pricing applies when related endoscopies are performed together. The claim should reflect the procedures actually performed and documented.

Can modifier 50 or an assistant-at-surgery claim be used?

Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 43266, and co-surgeons and team surgery are not permitted.

What documentation supports reporting 43266?

Document the clinical target and reason for stenting, the stent deployment, and any dilation performed. The record should distinguish stent placement from evaluation or dilation alone.

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 43266PPRRVU2026_Oct_nonQPP.csv, line 5,194 (RVU26D)

Open CMS sourceHow we calculate rates

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