$413.39
Choose 43206 for optical microscopic imaging during esophagoscopy. Choose 43202 when tissue is sampled for histologic examination.
On this page
CMS RVU26D · Effective 2026-10-01
43206 Esophagoscopy Medicare reimbursement rates in Colorado
Report flexible transoral esophagoscopy with optical endomicroscopy when microscopic imaging is used to assess esophageal mucosa during the endoscopic examination. Compare 43206 office and facility rates across CMS payment localities in Colorado.
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 43206 in Colorado?
Colorado 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
$356.00
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$120.02
1 of 1 localities have a supported rate.
Payment area: Colorado
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.
Gastroenterology
About 43206: Esophagoscopy with optical endomicroscopy
Report flexible transoral esophagoscopy with optical endomicroscopy when microscopic imaging is used to assess esophageal mucosa during the endoscopic examination.
A gastroenterologist or other qualified endoscopist uses a flexible scope passed through the mouth to examine the esophagus and obtain microscopic images of its lining in real time. The added imaging can help characterize abnormal mucosa, including areas evaluated during assessment of Barrett’s esophagus. It provides an optical view of tissue architecture rather than a specimen for conventional histologic examination.
Choose this service when the procedure record documents optical endomicroscopy during flexible transoral esophagoscopy, including the examined area and imaging findings. A tissue biopsy or brush sampling is a different service; when related endoscopies are performed together, CMS endoscopy-family pricing applies. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate for this single esophageal service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43206
- 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 RVU2.23 · 22%
- Practice expense (office) RVU7.72 · 76%
- Malpractice RVU0.24 · 2%
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.
43206 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Code 43231 describes esophageal endoscopic ultrasound examination; 43206 describes optical endomicroscopic imaging of the esophageal lining.
$337.49
Code 43235 is an EGD service involving examination beyond the esophagus, with brush or wash sampling. Code 43206 is limited to esophagoscopy with optical endomicroscopy.
Compare 43206 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
Colorado →
Office / nonfacility
$356.00
Facility
$120.02
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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 43206 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,145
- Code
- 43206
- Physician work
- 2.23
- Practice expense
- 7.72
- Malpractice
- 0.24
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.23 | × 1.012 | 2.2568 |
| Practice expense | 7.72 | × 1.064 | 8.2141 |
| Malpractice | 0.24 | × 0.781 | 0.1874 |
| Total RVUs | 10.6583 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$356.00
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.23 | 1.012 |
| Practice expense | 7.72 | 1.064 |
| Malpractice | 0.24 | 0.781 |
(2.23 × 1.012 + 7.72 × 1.064 + 0.24 × 0.781) × $33.4009 = $356.00
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.23 | 1.012 |
| Practice expense | 1.08 | 1.064 |
| Malpractice | 0.24 | 0.781 |
(2.23 × 1.012 + 1.08 × 1.064 + 0.24 × 0.781) × $33.4009 = $120.02
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.
43206 billing questions
How does this differ from esophageal biopsy code 43202?
Code 43206 captures optical microscopic imaging of the esophageal lining; 43202 captures tissue sampling for histologic examination. Document the imaging and any biopsy separately when both are performed.
Is this an EGD that includes the stomach and duodenum?
No. This service is flexible transoral esophagoscopy with optical endomicroscopy. An EGD code describes examination extending beyond the esophagus.
Should modifier 50 be appended?
No. The esophageal service is not bilateral work, and modifier 50 is inappropriate.
What documentation supports reporting 43206?
Record the flexible transoral esophagoscopy, use of optical endomicroscopy, the esophageal area assessed, and the imaging findings.
How is it handled when another related endoscopy is performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The record should identify each procedure actually performed.
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.
5,14243202,,Esophagoscopy flex biopsy,A,,1.68,9.88,,0.90,,0.21,11.77,2.79,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14343204,,Esoph scope w/sclerosis inj,A,,2.27,1.09,NA,1.09,,0.25,3.61,3.61,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14443205,,Esophagus endoscopy/ligation,A,,2.38,1.13,NA,1.13,,0.26,3.77,3.77,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14543206,,Esoph optical endomicroscopy,A,,2.23,7.72,,1.08,,0.24,10.19,3.55,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,1464320F,,Pt talk psychsoc&rx oh dpnd,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
5,14743210,,Egd esophagogastrc fndoplsty,A,,7.56,2.70,NA,2.70,,1.10,11.36,11.36,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,14843211,,Esophagoscop mucosal resect,A,,4.10,1.64,NA,1.64,,0.45,6.19,6.19,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899