No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
43246 PEG placement Medicare reimbursement rates in Arkansas
Reports endoscopically guided placement of a gastrostomy tube to provide stomach access for patients who cannot maintain adequate oral intake. Compare 43246 office and facility rates across CMS payment localities in Arkansas.
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.
What does Medicare pay for 43246 in Arkansas?
Arkansas has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$163.46
1 of 1 localities have a supported rate.
Payment area: Arkansas
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Gastrointestinal endoscopy
About 43246: Endoscopic gastrostomy tube placement
Reports endoscopically guided placement of a gastrostomy tube to provide stomach access for patients who cannot maintain adequate oral intake.
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.
CMS billing rules for 43246
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.47 · 65%
- Practice expense (office) RVU1.34 · 25%
- Malpractice RVU0.53 · 10%
46.6K
Medicare services in 2024 · #806 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.
43246 compared with similar codes
Office rates for Arkansas, from the same CMS release.
$690.21
Both establish gastrostomy access, but 43246 uses endoscopic guidance and 49440 uses a radiologic approach.
$284.01
43235 describes a diagnostic EGD. The examination used to guide gastrostomy tube placement is part of 43246, not a separate diagnostic service by itself.
Compare 43246 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Arkansas →
Office / nonfacility
Unavailable
Facility
$163.46
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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 43246 in Arkansas.
PPRRVU2026_Oct_nonQPP.csv
5,174
- Code
- 43246
- Physician work
- 3.47
- Practice expense
- 1.34
- Malpractice
- 0.53
GPCI2026.csv
7
- Locality
- Arkansas
- Physician work
- 1.000
- Practice expense
- 0.859
- Malpractice
- 0.515
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.47 | × 1.000 | 3.4700 |
| Practice expense | 1.34 | × 0.859 | 1.1511 |
| Malpractice | 0.53 | × 0.515 | 0.2730 |
| Total RVUs | 4.8940 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Arkansas$163.46
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.47 | 1 |
| Practice expense | 1.34 | 0.859 |
| Malpractice | 0.53 | 0.515 |
(3.47 × 1 + 1.34 × 0.859 + 0.53 × 0.515) × $33.4009 = $163.46
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.
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 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.
5,17143243,,Egd injection varices,A,,4.16,1.57,NA,1.57,,0.53,6.26,6.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17243244,,Egd varices ligation,A,,4.29,1.69,NA,1.69,,0.47,6.45,6.45,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17343245,,Egd dilate stricture,A,,3.00,16.19,,1.28,,0.42,19.61,4.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17443246,,Egd place gastrostomy tube,A,,3.47,1.34,NA,1.34,,0.53,5.34,5.34,0,000,0.00,0.00,0.00,3,0,0,2,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17543247,,Egd remove foreign body,A,,3.03,9.35,,1.30,,0.38,12.76,4.71,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17643248,,Egd guide wire insertion,A,,2.84,10.53,,1.25,,0.34,13.71,4.43,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17743249,,Esoph egd dilation <30 mm,A,,2.60,32.44,,1.18,,0.30,35.34,4.08,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609
901112,CA,55,CHICO,1.017,1.096,0.536
1001182,CA,71,EL CENTRO,1.017,1.096,0.541