$542.52
43290 is for placing the intragastric balloon; 43291 is for removing one that is already in place.
On this page
CMS RVU26D · Effective 2026-10-01
43290 in Merced
Office / nonfacility
$2910.20
Base rate per service
Facility setting
$157.69
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.
Gastrointestinal endoscopy
About 43290: Transoral intragastric balloon placement
Reports endoscopic placement of an intragastric balloon for weight management, rather than diagnostic examination alone or later balloon removal.
A gastroenterologist or other endoscopist guides an intragastric balloon through the mouth and places it in the stomach during an upper endoscopic procedure. The service is used in balloon-based weight-management treatment, usually in an outpatient endoscopy setting or hospital outpatient facility. It represents placement, not removal of a balloon that was already in place.
Report this code when the balloon is actually placed; documentation should identify the endoscopic service and confirm placement. The procedure has 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 for this service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43290
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- 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 RVU3.03 · 4%
- Practice expense (office) RVU76.51 · 96%
- Malpractice RVU0.36 · 0%
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.
43290 compared with similar codes
Office rates for Merced, from the same CMS release.
$343.76
43235 describes diagnostic upper endoscopy. Use 43290 when the balloon is placed, rather than reporting diagnostic examination alone.
$447.86
43239 describes upper endoscopy with biopsy. It does not represent balloon placement; report biopsy only when tissue sampling is separately performed and documented.
The same code, a different location
How does Merced compare?
In Bakersfield, the office rate for 43290 is $2911.28—$1.08 higher than the $2910.20 rate in Merced. Both use the same code, release and participation basis.
43290 across payment areas
Same release and payment basis · bars start at $0
Merced · This locality
$2910.20
$2911.28
$1.08 higher than Merced
$2910.20
The same base rate than Merced
$2910.26
$0.06 higher than Merced
$2910.20
The same base rate than Merced
$2910.20
The same base rate than Merced
$226.30 higher than Merced
Other payment areas listed in California 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, 43290 ranges from $2302.57 in Arkansas to $3803.82 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
Madera
California · 43290
Office
$2910.20
Facility
$157.69
The same base rate than Merced for the office setting.
Modesto
California · 43290
Office
$2910.20
Facility
$157.69
The same base rate than Merced for the office setting.
Napa
California · 43290
Office
$3481.84
Facility
$171.80
$571.64 higher than Merced for the office setting.
Oxnard-Thousand Oaks-Ventura
California · 43290
Office
$3132.13
Facility
$163.64
$221.93 higher than Merced for the office setting.
Redding
California · 43290
Office
$2910.20
Facility
$157.69
The same base rate than Merced for the office setting.
Rest Of California
California · 43290
Office
$2910.20
Facility
$157.69
The same base rate than Merced for the office setting.
Riverside-San Bernardino-Ontario
California · 43290
Office
$2914.11
Facility
$161.60
$3.91 higher than Merced for the office setting.
Sacramento-Roseville-Folsom
California · 43290
Office
$3083.34
Facility
$162.57
$173.14 higher than Merced for the office setting.
Salinas
California · 43290
Office
$3072.61
Facility
$161.89
$162.41 higher than Merced for the office setting.
San Diego-Chula Vista-Carlsbad
California · 43290
Office
$3167.14
Facility
$163.49
$256.94 higher than Merced for the office setting.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 43290
Office
$3719.60
Facility
$178.50
$809.40 higher than Merced for the office setting.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 43290
Office
$3719.19
Facility
$178.10
$808.99 higher than Merced for the office setting.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 43290
Office
$3803.82
Facility
$182.36
$893.62 higher than Merced for the office setting.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 43290
Office
$3802.15
Facility
$180.69
$891.95 higher than Merced for the office setting.
San Luis Obispo-Paso Robles
California · 43290
Office
$3020.09
Facility
$159.59
$109.89 higher than Merced for the office setting.
Santa Cruz-Watsonville
California · 43290
Office
$3214.71
Facility
$163.34
$304.51 higher than Merced for the office setting.
Santa Maria-Santa Barbara
California · 43290
Office
$3090.20
Facility
$161.89
$180.00 higher than Merced for the office setting.
Santa Rosa-Petaluma
California · 43290
Office
$3248.84
Facility
$164.83
$338.64 higher than Merced for the office setting.
Stockton
California · 43290
Office
$2910.20
Facility
$157.69
The same base rate than Merced for the office setting.
Vallejo
California · 43290
Office
$3481.25
Facility
$171.21
$571.05 higher than Merced for the office setting.
Visalia
California · 43290
Office
$2910.20
Facility
$157.69
The same base rate than Merced for the office setting.
Yuba City
California · 43290
Office
$2910.20
Facility
$157.69
The same base rate than Merced for the office setting.
Dc + Md/Va Suburbs
District of Columbia · 43290
Office
$3130.44
Facility
$171.99
$220.24 higher than Merced for the office setting.
Miami
Florida · 43290
Office
$2791.89
Facility
$177.51
$118.31 lower than Merced for the office setting.
Chicago
Illinois · 43290
Office
$2697.79
Facility
$173.82
$212.41 lower than Merced for the office setting.
Manhattan
New York · 43290
Office
$3096.25
Facility
$177.98
$186.05 higher than Merced for the office setting.
Alaska*
Alaska · 43290
Office
$2880.04
Facility
$205.39
$30.16 lower than Merced for the office setting.
Alabama
Alabama · 43290
Office
$2344.08
Facility
$146.59
$566.12 lower than Merced for the office setting.
Arkansas
Arkansas · 43290
Office
$2302.57
Facility
$145.27
$607.63 lower than Merced for the office setting.
Arizona
Arizona · 43290
Office
$2587.78
Facility
$154.22
$322.42 lower than Merced for the office setting.
Colorado
Colorado · 43290
Office
$2830.87
Facility
$158.72
$79.33 lower than Merced for the office setting.
Connecticut
Connecticut · 43290
Office
$2870.05
Facility
$165.26
$40.15 lower than Merced for the office setting.
Delaware
Delaware · 43290
Office
$2637.36
Facility
$156.08
$272.84 lower than Merced for the office setting.
Fort Lauderdale
Florida · 43290
Office
$2711.67
Facility
$167.61
$198.53 lower than Merced for the office setting.
Rest Of Florida
Florida · 43290
Office
$2562.34
Facility
$161.43
$347.86 lower than Merced for the office setting.
Atlanta
Georgia · 43290
Office
$2712.34
Facility
$160.74
$197.86 lower than Merced for the office setting.
Rest Of Georgia
Georgia · 43290
Office
$2395.05
Facility
$154.87
$515.15 lower than Merced for the office setting.
Hawaii, Guam
Hawaii · 43290
Office
$3013.77
Facility
$158.30
$103.57 higher than Merced for the office setting.
Iowa
Iowa · 43290
Office
$2444.26
Facility
$146.32
$465.94 lower than Merced for the office setting.
Idaho
Idaho · 43290
Office
$2457.95
Facility
$147.45
$452.25 lower than Merced for the office setting.
East St. Louis
Illinois · 43290
Office
$2476.48
Facility
$165.98
$433.72 lower than Merced for the office setting.
Rest Of Illinois
Illinois · 43290
Office
$2453.17
Facility
$160.25
$457.03 lower than Merced for the office setting.
Suburban Chicago
Illinois · 43290
Office
$2747.72
Facility
$168.50
$162.48 lower than Merced for the office setting.
Indiana
Indiana · 43290
Office
$2476.00
Facility
$147.92
$434.20 lower than Merced for the office setting.
Kansas
Kansas · 43290
Office
$2417.44
Facility
$147.12
$492.76 lower than Merced for the office setting.
Kentucky
Kentucky · 43290
Office
$2384.05
Facility
$151.40
$526.15 lower than Merced for the office setting.
New Orleans
Louisiana · 43290
Office
$2519.59
Facility
$156.35
$390.61 lower than Merced for the office setting.
Rest Of Louisiana
Louisiana · 43290
Office
$2374.34
Facility
$151.74
$535.86 lower than Merced for the office setting.
Metropolitan Boston
Massachusetts · 43290
Office
$3167.33
Facility
$168.70
$257.13 higher than Merced for the office setting.
Rest Of Massachusetts
Massachusetts · 43290
Office
$2803.35
Facility
$158.83
$106.85 lower than Merced for the office setting.
Baltimore/Surr. Cntys
Maryland · 43290
Office
$2859.75
Facility
$165.01
$50.45 lower than Merced for the office setting.
Rest Of Maryland
Maryland · 43290
Office
$2699.42
Facility
$157.87
$210.78 lower than Merced for the office setting.
Rest Of Maine
Maine · 43290
Office
$2459.75
Facility
$149.25
$450.45 lower than Merced for the office setting.
Southern Maine
Maine · 43290
Office
$2641.30
Facility
$152.48
$268.90 lower than Merced for the office setting.
Detroit
Michigan · 43290
Office
$2587.54
Facility
$164.02
$322.66 lower than Merced for the office setting.
Rest Of Michigan
Michigan · 43290
Office
$2447.95
Facility
$155.03
$462.25 lower than Merced for the office setting.
Minnesota
Minnesota · 43290
Office
$2734.38
Facility
$150.13
$175.82 lower than Merced for the office setting.
Metropolitan Kansas City
Missouri · 43290
Office
$2512.57
Facility
$154.35
$397.63 lower than Merced for the office setting.
Metropolitan St. Louis
Missouri · 43290
Office
$2546.09
Facility
$155.23
$364.11 lower than Merced for the office setting.
Rest Of Missouri
Missouri · 43290
Office
$2315.76
Facility
$150.92
$594.44 lower than Merced for the office setting.
Mississippi
Mississippi · 43290
Office
$2310.38
Facility
$148.05
$599.82 lower than Merced for the office setting.
Montana**
Montana · 43290
Office
$2668.71
Facility
$157.29
$241.49 lower than Merced for the office setting.
North Carolina
North Carolina · 43290
Office
$2493.17
Facility
$150.02
$417.03 lower than Merced for the office setting.
North Dakota**
North Dakota · 43290
Office
$2661.59
Facility
$150.18
$248.61 lower than Merced for the office setting.
Nebraska
Nebraska · 43290
Office
$2464.48
Facility
$146.44
$445.72 lower than Merced for the office setting.
New Hampshire
New Hampshire · 43290
Office
$2772.00
Facility
$157.62
$138.20 lower than Merced for the office setting.
Northern Nj
New Jersey · 43290
Office
$3084.81
Facility
$171.57
$174.61 higher than Merced for the office setting.
Rest Of New Jersey
New Jersey · 43290
Office
$2909.05
Facility
$166.59
$1.15 lower than Merced for the office setting.
New Mexico
New Mexico · 43290
Office
$2459.04
Facility
$156.08
$451.16 lower than Merced for the office setting.
Nevada**
Nevada · 43290
Office
$2669.28
Facility
$155.35
$240.92 lower than Merced for the office setting.
Nyc Suburbs/Long Island
New York · 43290
Office
$3168.50
Facility
$182.43
$258.30 higher than Merced for the office setting.
Poughkpsie/N Nyc Suburbs
New York · 43290
Office
$2918.58
Facility
$168.59
$8.38 higher than Merced for the office setting.
Queens
New York · 43290
Office
$3145.63
Facility
$177.13
$235.43 higher than Merced for the office setting.
Rest Of New York
New York · 43290
Office
$2537.39
Facility
$151.54
$372.81 lower than Merced for the office setting.
Ohio
Ohio · 43290
Office
$2446.50
Facility
$153.58
$463.70 lower than Merced for the office setting.
Oklahoma
Oklahoma · 43290
Office
$2392.61
Facility
$149.92
$517.59 lower than Merced for the office setting.
Portland
Oregon · 43290
Office
$2950.93
Facility
$160.75
$40.73 higher than Merced for the office setting.
Rest Of Oregon
Oregon · 43290
Office
$2654.94
Facility
$153.57
$255.26 lower than Merced for the office setting.
Metropolitan Philadelphia
Pennsylvania · 43290
Office
$2777.65
Facility
$163.27
$132.55 lower than Merced for the office setting.
Rest Of Pennsylvania
Pennsylvania · 43290
Office
$2458.52
Facility
$153.04
$451.68 lower than Merced for the office setting.
Puerto Rico
Puerto Rico · 43290
Office
$2696.66
Facility
$157.62
$213.54 lower than Merced for the office setting.
Rhode Island
Rhode Island · 43290
Office
$2753.69
Facility
$159.40
$156.51 lower than Merced for the office setting.
South Carolina
South Carolina · 43290
Office
$2472.71
Facility
$152.16
$437.49 lower than Merced for the office setting.
South Dakota**
South Dakota · 43290
Office
$2660.75
Facility
$149.33
$249.45 lower than Merced for the office setting.
Tennessee
Tennessee · 43290
Office
$2430.61
Facility
$147.74
$479.59 lower than Merced for the office setting.
Austin
Texas · 43290
Office
$2815.78
Facility
$158.71
$94.42 lower than Merced for the office setting.
Beaumont
Texas · 43290
Office
$2437.88
Facility
$152.50
$472.32 lower than Merced for the office setting.
Brazoria
Texas · 43290
Office
$2643.90
Facility
$155.09
$266.30 lower than Merced for the office setting.
Dallas
Texas · 43290
Office
$2657.71
Facility
$156.35
$252.49 lower than Merced for the office setting.
Fort Worth
Texas · 43290
Office
$2632.31
Facility
$156.06
$277.89 lower than Merced for the office setting.
Galveston
Texas · 43290
Office
$2649.58
Facility
$155.75
$260.62 lower than Merced for the office setting.
Houston
Texas · 43290
Office
$2656.17
Facility
$162.34
$254.03 lower than Merced for the office setting.
Rest Of Texas
Texas · 43290
Office
$2537.23
Facility
$153.90
$372.97 lower than Merced for the office setting.
Utah
Utah · 43290
Office
$2514.18
Facility
$153.45
$396.02 lower than Merced for the office setting.
Virginia
Virginia · 43290
Office
$2621.75
Facility
$153.03
$288.45 lower than Merced for the office setting.
Virgin Islands
United States Virgin Islands · 43290
Office
$2696.66
Facility
$157.62
$213.54 lower than Merced for the office setting.
Vermont
Vermont · 43290
Office
$2637.24
Facility
$150.94
$272.96 lower than Merced for the office setting.
Rest Of Washington
Washington · 43290
Office
$2802.62
Facility
$158.10
$107.58 lower than Merced for the office setting.
Seattle (King Cnty)
Washington · 43290
Office
$3251.69
Facility
$170.19
$341.49 higher than Merced for the office setting.
Wisconsin
Wisconsin · 43290
Office
$2553.08
Facility
$147.15
$357.12 lower than Merced for the office setting.
West Virginia
West Virginia · 43290
Office
$2339.14
Facility
$156.73
$571.06 lower than Merced for the office setting.
Wyoming**
Wyoming · 43290
Office
$2665.61
Facility
$154.19
$244.59 lower than Merced for the office setting.
See how rates vary across the country
43290 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
$2,302.57
$3,357.01
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $2,880.04 | 1 |
| AL | $2,344.08 | 1 |
| AR | $2,302.57 | 1 |
| AZ | $2,587.78 | 1 |
| CA | $2,910.20–$3,803.82 | 29 |
| CO | $2,830.87 | 1 |
| CT | $2,870.05 | 1 |
| DC | $3,130.44 | 1 |
| DE | $2,637.36 | 1 |
| FL | $2,562.34–$2,791.89 | 3 |
| GA | $2,395.05–$2,712.34 | 2 |
| GU | $3,013.77 | 1 |
| HI | $3,013.77 | 1 |
| IA | $2,444.26 | 1 |
| ID | $2,457.95 | 1 |
| IL | $2,453.17–$2,747.72 | 4 |
| IN | $2,476.00 | 1 |
| KS | $2,417.44 | 1 |
| KY | $2,384.05 | 1 |
| LA | $2,374.34–$2,519.59 | 2 |
| MA | $2,803.35–$3,167.33 | 2 |
| MD | $2,699.42–$3,130.44 | 3 |
| ME | $2,459.75–$2,641.30 | 2 |
| MI | $2,447.95–$2,587.54 | 2 |
| MN | $2,734.38 | 1 |
| MO | $2,315.76–$2,546.09 | 3 |
| MS | $2,310.38 | 1 |
| MT | $2,668.71 | 1 |
| NC | $2,493.17 | 1 |
| ND | $2,661.59 | 1 |
| NE | $2,464.48 | 1 |
| NH | $2,772.00 | 1 |
| NJ | $2,909.05–$3,084.81 | 2 |
| NM | $2,459.04 | 1 |
| NV | $2,669.28 | 1 |
| NY | $2,537.39–$3,168.50 | 5 |
| OH | $2,446.50 | 1 |
| OK | $2,392.61 | 1 |
| OR | $2,654.94–$2,950.93 | 2 |
| PA | $2,458.52–$2,777.65 | 2 |
| PR | $2,696.66 | 1 |
| RI | $2,753.69 | 1 |
| SC | $2,472.71 | 1 |
| SD | $2,660.75 | 1 |
| TN | $2,430.61 | 1 |
| TX | $2,437.88–$2,815.78 | 8 |
| UT | $2,514.18 | 1 |
| VA | $2,621.75–$3,130.44 | 2 |
| VI | $2,696.66 | 1 |
| VT | $2,637.24 | 1 |
| WA | $2,802.62–$3,251.69 | 2 |
| WI | $2,553.08 | 1 |
| WV | $2,339.14 | 1 |
| WY | $2,665.61 | 1 |
Where does this rate apply?
Merced is a Medicare payment area. Our Census mapping connects it to 24 cities and communities in California, 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.
Why are the office and facility amounts different?
For 43290 in Merced, the physician’s office rate is $2910.20 and the facility-setting rate is $157.69: a difference of $2752.51.
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.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 43290 in Merced. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$3201.22
$2910.20 × 110% = $3201.22
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.
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 43290 in Merced.
PPRRVU2026_Oct_nonQPP.csv
5,215
- Code
- 43290
- Physician work
- 3.03
- Practice expense
- 76.51
- Malpractice
- 0.36
GPCI2026.csv
15
- Locality
- Merced
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.03 | × 1.017 | 3.0815 |
| Practice expense | 76.51 | × 1.096 | 83.8550 |
| Malpractice | 0.36 | × 0.536 | 0.1930 |
| Total RVUs | 87.1294 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Merced$2910.20
Open 43290 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.03 | 1.017 |
| Practice expense | 76.51 | 1.096 |
| Malpractice | 0.36 | 0.536 |
(3.03 × 1.017 + 76.51 × 1.096 + 0.36 × 0.536) × $33.4009 = $2910.20
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.03 | 1.017 |
| Practice expense | 1.32 | 1.096 |
| Malpractice | 0.36 | 0.536 |
(3.03 × 1.017 + 1.32 × 1.096 + 0.36 × 0.536) × $33.4009 = $157.69
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
43290 · Office / nonfacility
$2910.20
Effective 2026-10-01
The base rate is $365.66 higher than on 2025-10-01, moving from $2544.54 to $2910.20 (14.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$2544.54changed to$2910.20
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.11 changed to 3.03
- Practice expense RVU 68.82 changed to 76.51
- Malpractice RVU 0.52 changed to 0.36
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
Earliest loaded release: $2544.54
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 from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $2910.20 | $157.69 | RVU26D |
| 2026-07-01 | $2910.20 | $157.69 | RVU26C |
| 2026-04-01 | $2910.20 | $157.69 | RVU26B |
| 2026-01-01 | $2910.20 | $157.69 | RVU26A |
| 2025-10-01 | $2544.54 | $170.82 | RVU25D |
| 2025-07-01 | $2544.54 | $170.82 | RVU25C |
| 2025-04-01 | $2544.54 | $170.82 | RVU25B |
| 2025-01-01 | $2544.54 | $170.82 | RVU25A |
43290 billing questions
How is placement distinguished from balloon removal?
Use 43290 for placing the intragastric balloon. Code 43291 describes endoscopic removal of an existing balloon.
Can a diagnostic EGD be reported separately?
The diagnostic inspection that is part of the balloon-placement procedure is not a separate service. A diagnostic EGD code is for an encounter in which no balloon placement is performed.
Should modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What happens when another related endoscopy is performed at the same session?
Endoscopy family pricing applies when related endoscopies are performed together. Documentation should identify each service actually performed.
Is an assistant or co-surgeon payable?
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.
5,21243288,,Esphg thrsc moblj,A,,64.76,22.49,NA,22.49,,16.45,103.70,103.70,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21343289,,Unlisted laps px esoph,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2144328F,,Pt asked re sleep disturb,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21543290,,Egd flx trnsorl dplmnt balo,A,,3.03,76.51,,1.32,,0.36,79.90,4.71,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,21643291,,Egd flx trnsorl rmvl balo,A,,2.73,12.14,,1.23,,0.30,15.17,4.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,21743300,,Repair of esophagus,A,,9.10,6.10,NA,6.10,,1.32,16.52,16.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21843305,,Repair esophagus and fistula,A,,17.65,8.02,NA,8.02,,2.58,28.25,28.25,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1201112,CA,57,HANFORD-CORCORAN,1.017,1.096,0.536
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623