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CMS RVU26D · Effective 2026-10-01

43235 in Delaware

Office / nonfacility

$319.23

Base rate per service

Facility setting

$109.68

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Gastroenterology endoscopy

About 43235: Diagnostic upper GI endoscopy with sampling

Reports a flexible upper endoscopic examination of the esophagus, stomach, and duodenum, including brush or wash cytology when performed without biopsy or therapy.

A flexible scope is passed through the mouth to examine the esophagus, stomach, and duodenum. When performed, brushings or washings collect cells or material for laboratory analysis; they are part of this service. Gastroenterologists and other physicians trained in upper endoscopy perform it in office, ambulatory, and hospital settings to evaluate upper gastrointestinal symptoms or findings when the examination is diagnostic.

Report this code when inspection, with or without brushings or washings, is performed without a biopsy or therapeutic intervention. The record should support the examined anatomy, findings, and any sampled site and method. A biopsy or endoscopic treatment calls for the corresponding procedure code rather than separate reporting of this diagnostic examination. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate; assistant-at-surgery services are not paid, and co-surgeons and team surgery are not permitted.

CMS billing rules for 43235

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU2.04 · 21%
  • Practice expense (office) RVU7.38 · 76%
  • Malpractice RVU0.24 · 2%

262.6K

Medicare services in 2024 · #335 by national volume

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.

43235 compared with similar codes

Office rates for Delaware, from the same CMS release.

43239

EGD with biopsy

Single or multiple biopsies

$414.34

43235 covers diagnostic inspection with brushings or washings when performed. Choose 43239 when forceps biopsy is performed during the upper endoscopy.

43237

Endoscopic ultrasound

Limited upper GI examination

No office rate

43237 includes endoscopic ultrasound examination. Choose 43235 for diagnostic inspection without the ultrasound service.

43245

EGD dilation

Gastric outlet obstruction

$647.59

43245 includes dilation of a stricture during upper endoscopy. 43235 is for diagnostic examination without that therapeutic work.

The same code, a different location

How does Delaware compare?

43235 across payment areas

Same release and payment basis · bars start at $0

  1. Delaware · This locality

    $319.23

  2. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $367.86

    $48.63 higher than Delaware

  3. Dc + Md/Va Suburbs

    $371.11

    $51.88 higher than Delaware

  4. Miami

    $345.02

    $25.79 higher than Delaware

  5. Chicago

    $334.74

    $15.51 higher than Delaware

  6. Manhattan

    $371.64

    $52.41 higher than Delaware

  7. Alaska*

    $369.14

    $49.91 higher than Delaware

Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 43235 ranges from $284.01 in Arkansas to $435.38 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Alabama

    Alabama · 43235

    Office

    $288.36

    Facility

    $102.78

    $30.87 lower than Delaware for the office setting.

  • Arkansas

    Arkansas · 43235

    Office

    $284.01

    Facility

    $101.82

    $35.22 lower than Delaware for the office setting.

  • Arizona

    Arizona · 43235

    Office

    $313.86

    Facility

    $108.34

    $5.37 lower than Delaware for the office setting.

  • Bakersfield

    California · 43235

    Office

    $344.48

    Facility

    $112.02

    $25.25 higher than Delaware for the office setting.

  • Chico

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • El Centro

    California · 43235

    Office

    $343.80

    Facility

    $111.34

    $24.57 higher than Delaware for the office setting.

  • Fresno

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Hanford-Corcoran

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Madera

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Merced

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Modesto

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Napa

    California · 43235

    Office

    $401.39

    Facility

    $121.85

    $82.16 higher than Delaware for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 43235

    Office

    $366.40

    Facility

    $115.70

    $47.17 higher than Delaware for the office setting.

  • Redding

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Rest Of California

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 43235

    Office

    $346.36

    Facility

    $113.91

    $27.13 higher than Delaware for the office setting.

  • Sacramento-Roseville-Folsom

    California · 43235

    Office

    $361.57

    Facility

    $114.90

    $42.34 higher than Delaware for the office setting.

  • Salinas

    California · 43235

    Office

    $360.24

    Facility

    $114.42

    $41.01 higher than Delaware for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 43235

    Office

    $369.34

    Facility

    $115.67

    $50.11 higher than Delaware for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 43235

    Office

    $425.85

    Facility

    $126.80

    $106.62 higher than Delaware for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 43235

    Office

    $425.58

    Facility

    $126.53

    $106.35 higher than Delaware for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 43235

    Office

    $435.38

    Facility

    $129.54

    $116.15 higher than Delaware for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 43235

    Office

    $434.27

    Facility

    $128.42

    $115.04 higher than Delaware for the office setting.

  • San Luis Obispo-Paso Robles

    California · 43235

    Office

    $354.35

    Facility

    $112.78

    $35.12 higher than Delaware for the office setting.

  • Santa Cruz-Watsonville

    California · 43235

    Office

    $373.36

    Facility

    $115.66

    $54.13 higher than Delaware for the office setting.

  • Santa Maria-Santa Barbara

    California · 43235

    Office

    $361.76

    Facility

    $114.46

    $42.53 higher than Delaware for the office setting.

  • Santa Rosa-Petaluma

    California · 43235

    Office

    $377.18

    Facility

    $116.73

    $57.95 higher than Delaware for the office setting.

  • Stockton

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Vallejo

    California · 43235

    Office

    $401.00

    Facility

    $121.45

    $81.77 higher than Delaware for the office setting.

  • Visalia

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Yuba City

    California · 43235

    Office

    $343.76

    Facility

    $111.30

    $24.53 higher than Delaware for the office setting.

  • Colorado

    Colorado · 43235

    Office

    $337.49

    Facility

    $111.82

    $18.26 higher than Delaware for the office setting.

  • Connecticut

    Connecticut · 43235

    Office

    $344.68

    Facility

    $116.25

    $25.45 higher than Delaware for the office setting.

  • Fort Lauderdale

    Florida · 43235

    Office

    $332.33

    Facility

    $117.48

    $13.10 higher than Delaware for the office setting.

  • Rest Of Florida

    Florida · 43235

    Office

    $315.84

    Facility

    $113.08

    $3.39 lower than Delaware for the office setting.

  • Atlanta

    Georgia · 43235

    Office

    $328.41

    Facility

    $112.92

    $9.18 higher than Delaware for the office setting.

  • Rest Of Georgia

    Georgia · 43235

    Office

    $297.57

    Facility

    $108.38

    $21.66 lower than Delaware for the office setting.

  • Hawaii, Guam

    Hawaii · 43235

    Office

    $353.05

    Facility

    $111.90

    $33.82 higher than Delaware for the office setting.

  • Iowa

    Iowa · 43235

    Office

    $296.87

    Facility

    $102.80

    $22.36 lower than Delaware for the office setting.

  • Idaho

    Idaho · 43235

    Office

    $298.71

    Facility

    $103.58

    $20.52 lower than Delaware for the office setting.

  • East St. Louis

    Illinois · 43235

    Office

    $311.06

    Facility

    $115.93

    $8.17 lower than Delaware for the office setting.

  • Rest Of Illinois

    Illinois · 43235

    Office

    $305.72

    Facility

    $112.08

    $13.51 lower than Delaware for the office setting.

  • Suburban Chicago

    Illinois · 43235

    Office

    $335.97

    Facility

    $118.15

    $16.74 higher than Delaware for the office setting.

  • Indiana

    Indiana · 43235

    Office

    $300.54

    Facility

    $103.93

    $18.69 lower than Delaware for the office setting.

  • Kansas

    Kansas · 43235

    Office

    $295.01

    Facility

    $103.28

    $24.22 lower than Delaware for the office setting.

  • Kentucky

    Kentucky · 43235

    Office

    $294.61

    Facility

    $106.06

    $24.62 lower than Delaware for the office setting.

  • New Orleans

    Louisiana · 43235

    Office

    $309.20

    Facility

    $109.62

    $10.03 lower than Delaware for the office setting.

  • Rest Of Louisiana

    Louisiana · 43235

    Office

    $293.97

    Facility

    $106.26

    $25.26 lower than Delaware for the office setting.

  • Metropolitan Boston

    Massachusetts · 43235

    Office

    $372.39

    Facility

    $119.14

    $53.16 higher than Delaware for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 43235

    Office

    $335.18

    Facility

    $111.84

    $15.95 higher than Delaware for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 43235

    Office

    $343.64

    Facility

    $116.06

    $24.41 higher than Delaware for the office setting.

  • Rest Of Maryland

    Maryland · 43235

    Office

    $325.63

    Facility

    $110.99

    $6.40 higher than Delaware for the office setting.

  • Rest Of Maine

    Maine · 43235

    Office

    $299.90

    Facility

    $104.77

    $19.33 lower than Delaware for the office setting.

  • Southern Maine

    Maine · 43235

    Office

    $317.48

    Facility

    $107.29

    $1.75 lower than Delaware for the office setting.

  • Detroit

    Michigan · 43235

    Office

    $319.52

    Facility

    $114.85

    $0.29 higher than Delaware for the office setting.

  • Rest Of Michigan

    Michigan · 43235

    Office

    $302.24

    Facility

    $108.60

    $16.99 lower than Delaware for the office setting.

  • Minnesota

    Minnesota · 43235

    Office

    $324.16

    Facility

    $105.91

    $4.93 higher than Delaware for the office setting.

  • Metropolitan Kansas City

    Missouri · 43235

    Office

    $307.43

    Facility

    $108.27

    $11.80 lower than Delaware for the office setting.

  • Metropolitan St. Louis

    Missouri · 43235

    Office

    $310.84

    Facility

    $108.92

    $8.39 lower than Delaware for the office setting.

  • Rest Of Missouri

    Missouri · 43235

    Office

    $288.43

    Facility

    $105.60

    $30.80 lower than Delaware for the office setting.

  • Mississippi

    Mississippi · 43235

    Office

    $286.30

    Facility

    $103.68

    $32.93 lower than Delaware for the office setting.

  • Montana**

    Montana · 43235

    Office

    $322.64

    Facility

    $110.54

    $3.41 higher than Delaware for the office setting.

  • North Carolina

    North Carolina · 43235

    Office

    $303.24

    Facility

    $105.36

    $15.99 lower than Delaware for the office setting.

  • North Dakota**

    North Dakota · 43235

    Office

    $317.89

    Facility

    $105.80

    $1.34 lower than Delaware for the office setting.

  • Nebraska

    Nebraska · 43235

    Office

    $298.69

    Facility

    $102.92

    $20.54 lower than Delaware for the office setting.

  • New Hampshire

    New Hampshire · 43235

    Office

    $331.76

    Facility

    $110.97

    $12.53 higher than Delaware for the office setting.

  • Northern Nj

    New Jersey · 43235

    Office

    $366.93

    Facility

    $120.90

    $47.70 higher than Delaware for the office setting.

  • Rest Of New Jersey

    New Jersey · 43235

    Office

    $348.83

    Facility

    $117.23

    $29.60 higher than Delaware for the office setting.

  • New Mexico

    New Mexico · 43235

    Office

    $303.80

    Facility

    $109.31

    $15.43 lower than Delaware for the office setting.

  • Nevada**

    Nevada · 43235

    Office

    $321.56

    Facility

    $109.25

    $2.33 higher than Delaware for the office setting.

  • Nyc Suburbs/Long Island

    New York · 43235

    Office

    $380.47

    Facility

    $128.29

    $61.24 higher than Delaware for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 43235

    Office

    $350.82

    Facility

    $118.57

    $31.59 higher than Delaware for the office setting.

  • Queens

    New York · 43235

    Office

    $375.42

    Facility

    $124.72

    $56.19 higher than Delaware for the office setting.

  • Rest Of New York

    New York · 43235

    Office

    $307.95

    Facility

    $106.46

    $11.28 lower than Delaware for the office setting.

  • Ohio

    Ohio · 43235

    Office

    $301.27

    Facility

    $107.63

    $17.96 lower than Delaware for the office setting.

  • Oklahoma

    Oklahoma · 43235

    Office

    $294.49

    Facility

    $105.09

    $24.74 lower than Delaware for the office setting.

  • Portland

    Oregon · 43235

    Office

    $349.05

    Facility

    $113.41

    $29.82 higher than Delaware for the office setting.

  • Rest Of Oregon

    Oregon · 43235

    Office

    $319.29

    Facility

    $108.04

    $0.06 higher than Delaware for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 43235

    Office

    $335.53

    Facility

    $114.74

    $16.30 higher than Delaware for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 43235

    Office

    $302.00

    Facility

    $107.30

    $17.23 lower than Delaware for the office setting.

  • Puerto Rico

    Puerto Rico · 43235

    Office

    $325.24

    Facility

    $110.82

    $6.01 higher than Delaware for the office setting.

  • Rhode Island

    Rhode Island · 43235

    Office

    $331.22

    Facility

    $112.12

    $11.99 higher than Delaware for the office setting.

  • South Carolina

    South Carolina · 43235

    Office

    $302.72

    Facility

    $106.74

    $16.51 lower than Delaware for the office setting.

  • South Dakota**

    South Dakota · 43235

    Office

    $317.33

    Facility

    $105.23

    $1.90 lower than Delaware for the office setting.

  • Tennessee

    Tennessee · 43235

    Office

    $296.51

    Facility

    $103.71

    $22.72 lower than Delaware for the office setting.

  • Austin

    Texas · 43235

    Office

    $336.17

    Facility

    $111.77

    $16.94 higher than Delaware for the office setting.

  • Beaumont

    Texas · 43235

    Office

    $299.90

    Facility

    $106.89

    $19.33 lower than Delaware for the office setting.

  • Brazoria

    Texas · 43235

    Office

    $319.22

    Facility

    $109.03

    $0.01 lower than Delaware for the office setting.

  • Dallas

    Texas · 43235

    Office

    $321.14

    Facility

    $109.89

    $1.91 higher than Delaware for the office setting.

  • Fort Worth

    Texas · 43235

    Office

    $318.78

    Facility

    $109.65

    $0.45 lower than Delaware for the office setting.

  • Galveston

    Texas · 43235

    Office

    $320.09

    Facility

    $109.48

    $0.86 higher than Delaware for the office setting.

  • Houston

    Texas · 43235

    Office

    $324.49

    Facility

    $113.88

    $5.26 higher than Delaware for the office setting.

  • Rest Of Texas

    Texas · 43235

    Office

    $309.30

    Facility

    $108.02

    $9.93 lower than Delaware for the office setting.

  • Utah

    Utah · 43235

    Office

    $307.05

    Facility

    $107.68

    $12.18 lower than Delaware for the office setting.

  • Virginia

    Virginia · 43235

    Office

    $316.11

    Facility

    $107.62

    $3.12 lower than Delaware for the office setting.

  • Virgin Islands

    United States Virgin Islands · 43235

    Office

    $325.24

    Facility

    $110.82

    $6.01 higher than Delaware for the office setting.

  • Vermont

    Vermont · 43235

    Office

    $316.23

    Facility

    $106.25

    $3.00 lower than Delaware for the office setting.

  • Rest Of Washington

    Washington · 43235

    Office

    $334.69

    Facility

    $111.35

    $15.46 higher than Delaware for the office setting.

  • Seattle (King Cnty)

    Washington · 43235

    Office

    $380.55

    Facility

    $120.31

    $61.32 higher than Delaware for the office setting.

  • Wisconsin

    Wisconsin · 43235

    Office

    $306.75

    Facility

    $103.56

    $12.48 lower than Delaware for the office setting.

  • West Virginia

    West Virginia · 43235

    Office

    $293.82

    Facility

    $109.51

    $25.41 lower than Delaware for the office setting.

  • Wyoming**

    Wyoming · 43235

    Office

    $320.57

    Facility

    $108.47

    $1.34 higher than Delaware for the office setting.

See how rates vary across the country

43235 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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.

$284.01

$389.57

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$369.141
AL$288.361
AR$284.011
AZ$313.861
CA$343.76–$435.3829
CO$337.491
CT$344.681
DC$371.111
DE$319.231
FL$315.84–$345.023
GA$297.57–$328.412
GU$353.051
HI$353.051
IA$296.871
ID$298.711
IL$305.72–$335.974
IN$300.541
KS$295.011
KY$294.611
LA$293.97–$309.202
MA$335.18–$372.392
MD$325.63–$371.113
ME$299.90–$317.482
MI$302.24–$319.522
MN$324.161
MO$288.43–$310.843
MS$286.301
MT$322.641
NC$303.241
ND$317.891
NE$298.691
NH$331.761
NJ$348.83–$366.932
NM$303.801
NV$321.561
NY$307.95–$380.475
OH$301.271
OK$294.491
OR$319.29–$349.052
PA$302.00–$335.532
PR$325.241
RI$331.221
SC$302.721
SD$317.331
TN$296.511
TX$299.90–$336.178
UT$307.051
VA$316.11–$371.112
VI$325.241
VT$316.231
WA$334.69–$380.552
WI$306.751
WV$293.821
WY$320.571

Explore 43235 on the national rate map →

Where does this rate apply?

Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in Delaware →

Why are the office and facility amounts different?

For 43235 in Delaware, the physician’s office rate is $319.23 and the facility-setting rate is $109.68: a difference of $209.55.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 43235 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$351.15

$319.23 × 110% = $351.15

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43235 in Delaware.

PPRRVU2026_Oct_nonQPP.csv

5,163

Code
43235
Physician work
2.04
Practice expense
7.38
Malpractice
0.24

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office / nonfacility calculation for 43235 in Delaware
ComponentRVULocality factorAdjusted
Physician work2.04× 1.0052.0502
Practice expense7.38× 0.9887.2914
Malpractice0.24× 0.8990.2158
Total RVUs9.5574
Conversion factor× 33.4009

Office / nonfacility rate, Delaware$319.23

Open 43235 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work2.041.005
Practice expense7.380.988
Malpractice0.240.899

(2.04 × 1.005 + 7.38 × 0.988 + 0.24 × 0.899) × $33.4009 = $319.23

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work2.041.005
Practice expense1.030.988
Malpractice0.240.899

(2.04 × 1.005 + 1.03 × 0.988 + 0.24 × 0.899) × $33.4009 = $109.68

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

43235 · Office / nonfacility

$319.23

Effective 2026-10-01

The base rate is $44.43 higher than on 2025-10-01, moving from $274.80 to $319.23 (16.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $274.80changed to$319.23

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.09 changed to 2.04
    • Practice expense RVU 6.18 changed to 7.38
    • Malpractice RVU 0.27 changed to 0.24
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $274.80

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$319.23$109.68RVU26D
2026-07-01$319.23$109.68RVU26C
2026-04-01$319.23$109.68RVU26B
2026-01-01$319.23$109.68RVU26A
2025-10-01$274.80$117.89RVU25D
2025-07-01$274.80$117.89RVU25C
2025-04-01$274.80$117.89RVU25B
2025-01-01$274.80$117.89RVU25A

43235 billing questions

When should 43239 be reported instead?

Use 43239 when forceps biopsy is performed during the upper endoscopy. Do not separately report this diagnostic examination for the same session.

Are brushings or washings separately billable?

No. Brushings or washings, when performed as part of the diagnostic examination, are included in 43235.

Can 43235 be reported with an endoscopic treatment?

When the same session includes a therapeutic upper endoscopic procedure, report the procedure performed rather than separately reporting the diagnostic examination.

Should modifier 50 be appended?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.

How does Medicare handle multiple procedures in one session?

The highest-valued procedure is paid in full; other procedures in the same session are paid at 50%. The 0-day global period includes same-day preoperative and postoperative care.

Can an assistant or co-surgeon be billed for this procedure?

Medicare does not pay an assistant at surgery for this service. 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 43235PPRRVU2026_Oct_nonQPP.csv, line 5,163 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet