No office rate
43237 is for the limited EUS examination without EUS-guided needle sampling. Choose 43238 when the applicable EGD/EUS service includes needle aspiration or biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
43237 Endoscopic ultrasound Medicare reimbursement rates in California
Upper gastrointestinal endoscopic ultrasound evaluates the esophageal, gastric, or duodenal wall and nearby structures when imaging beyond standard endoscopy is needed. Compare 43237 office and facility rates across CMS payment localities in California.
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 43237 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$173.60–$200.51
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $26.91 per service.
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.
Where 43237 pays more and less in California
Endoscopy
About 43237: Limited upper GI endoscopic ultrasound
Upper gastrointestinal endoscopic ultrasound evaluates the esophageal, gastric, or duodenal wall and nearby structures when imaging beyond standard endoscopy is needed.
A gastroenterologist advances an endoscope with an ultrasound probe to assess the wall of the esophagus, stomach, or duodenum and adjacent structures. Common reasons include evaluating a subepithelial lesion, assessing wall layers, or examining nearby lymph nodes or pancreaticobiliary structures that are within the scope of the study. The service is performed in an endoscopy unit, ambulatory surgery center, or hospital facility.
Report this code when the EUS examination is limited to the specified upper gastrointestinal region and no EUS-guided needle aspiration or biopsy is performed. Document the indication, anatomic extent, structures examined, findings, and any sampling performed; needle sampling changes the code selection. CMS assigns 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, and CMS does not pay an assistant at surgery, co-surgeons, or a team of surgeons for this service.
CMS billing rules for 43237
- 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 RVU3.38 · 65%
- Practice expense (office) RVU1.42 · 27%
- Malpractice RVU0.38 · 7%
21.3K
Medicare services in 2024 · #1122 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.
43237 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
43237 is limited to the specified upper gastrointestinal region. 43259 describes an EUS examination with a broader anatomic extent.
No office rate
43231 uses esophagoscopy for an EUS examination limited to the esophagus; 43237 is the EGD-based service for the specified upper GI regions.
$447.86–$569.97
43239 covers conventional mucosal biopsy during EGD. It is not the code for EUS-guided needle sampling of a lesion.
Compare 43237 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.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $174.75 |
| Chico | Office Unavailable | Facility $173.60 |
| El Centro | Office Unavailable | Facility $173.66 |
| Fresno | Office Unavailable | Facility $173.60 |
| Hanford-Corcoran | Office Unavailable | Facility $173.60 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $182.06 |
| Madera | Office Unavailable | Facility $173.60 |
| Merced | Office Unavailable | Facility $173.60 |
| Modesto | Office Unavailable | Facility $173.60 |
| Napa | Office Unavailable | Facility $188.97 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $180.02 |
| Redding | Office Unavailable | Facility $173.60 |
| Rest Of California | Office Unavailable | Facility $173.60 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $177.74 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $178.92 |
| Salinas | Office Unavailable | Facility $178.17 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $179.89 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $196.32 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $195.89 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $200.51 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $198.75 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $175.64 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $179.70 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $178.16 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $181.33 |
| Stockton | Office Unavailable | Facility $173.60 |
| Vallejo | Office Unavailable | Facility $188.35 |
| Visalia | Office Unavailable | Facility $173.60 |
| Yuba City | Office Unavailable | Facility $173.60 |
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43237 billing questions
When should 43237 be used instead of 43238?
Use 43237 for the limited EUS examination without EUS-guided needle aspiration or biopsy. When needle sampling is performed, use the applicable sampling code, such as 43238.
Can the diagnostic EGD be billed separately with 43237?
The endoscopic access and examination needed to perform the EUS are part of the service. Do not separately report a diagnostic EGD for that same examination.
How does 43237 differ from 43259?
43237 describes an examination limited to the esophagus, stomach, or duodenum and adjacent structures. Use 43259 when the examination includes the broader anatomic extent specified for that code.
Should modifier 50 be appended for bilateral findings?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.
What documentation supports reporting 43237?
Document why EUS was needed, the anatomic region examined, the structures assessed, and the findings. State whether needle aspiration or biopsy occurred, since that affects code selection.
Are assistant surgeon or co-surgeon services payable with 43237?
CMS does not pay an assistant at surgery for this service and does not permit co-surgeons or team surgery.
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.
5,16243233,,Egd balloon dil esoph30 mm/>,A,,3.97,1.52,NA,1.52,,0.62,6.11,6.11,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16343235,,Egd diagnostic brush wash,A,,2.04,7.38,,1.03,,0.24,9.66,3.31,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,16443236,,Uppr gi scope w/submuc inj,A,,2.33,10.76,,1.10,,0.27,13.36,3.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16543237,,Endoscopic us exam esoph,A,,3.38,1.42,NA,1.42,,0.38,5.18,5.18,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16643238,,Egd us fine needle bx/aspir,A,,4.06,1.62,NA,1.62,,0.44,6.12,6.12,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16743239,,Egd biopsy single/multiple,A,,2.33,9.94,,1.10,,0.27,12.54,3.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16843240,,Egd w/transmural drain cyst,A,,6.97,2.48,NA,2.48,,0.79,10.24,10.24,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00