No office rate
Both use a rigid transoral scope, but 43193 includes biopsy; 43191 is for diagnostic examination without biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
43193 Esophagoscopy Medicare reimbursement rates in Connecticut
Reports rigid transoral examination of the esophagus with tissue biopsy, commonly used to sample a visible lesion or abnormal mucosa. Compare 43193 office and facility rates across CMS payment localities in Connecticut.
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 43193 in Connecticut?
Connecticut 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
$156.00
1 of 1 localities have a supported rate.
Payment area: Connecticut
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.
Endoscopy
About 43193: Rigid transoral esophagoscopy with biopsy
Reports rigid transoral examination of the esophagus with tissue biopsy, commonly used to sample a visible lesion or abnormal mucosa.
A rigid scope is passed through the mouth to examine the esophagus and obtain tissue from an area requiring histologic evaluation. Otolaryngologists and other surgeons may perform this procedure, often in a facility setting, when evaluating a suspicious mucosal lesion, abnormal tissue, or another finding that needs biopsy. The code includes the esophageal examination and biopsy sampling, whether one or multiple specimens are taken.
Select 43193 when tissue is sampled using a rigid transoral approach; a diagnostic examination without biopsy is a different service. The record should identify the approach, the esophageal finding, and the biopsy performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Endoscopy family pricing applies when related endoscopies are performed together. Bilateral adjustment is not appropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43193
- 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 RVU2.72 · 61%
- Practice expense (office) RVU1.30 · 29%
- Malpractice RVU0.41 · 9%
173
Medicare services in 2024 · #4456 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.
43193 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$232.64
Both include esophageal biopsy. Choose 43193 for a rigid transoral approach and 43198 for a flexible transnasal approach.
No office rate
43192 describes injection during rigid transoral esophagoscopy, while 43193 describes biopsy.
No office rate
43194 is used when the rigid transoral procedure removes a foreign body; 43193 is used when it obtains tissue for biopsy.
Compare 43193 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$156.00
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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 43193 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,134
- Code
- 43193
- Physician work
- 2.72
- Practice expense
- 1.30
- Malpractice
- 0.41
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.72 | × 1.020 | 2.7744 |
| Practice expense | 1.30 | × 1.077 | 1.4001 |
| Malpractice | 0.41 | × 1.210 | 0.4961 |
| Total RVUs | 4.6706 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$156.00
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.72 | 1.02 |
| Practice expense | 1.3 | 1.077 |
| Malpractice | 0.41 | 1.21 |
(2.72 × 1.02 + 1.3 × 1.077 + 0.41 × 1.21) × $33.4009 = $156.00
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.
43193 billing questions
How does 43193 differ from 43191?
43193 includes biopsy with a rigid transoral esophagoscopy. Use 43191 for a rigid transoral diagnostic examination without biopsy.
Can multiple biopsy samples be reported as multiple units?
The code covers single or multiple biopsies during the procedure. Do not report a separate unit for each sample.
How does 43193 differ from 43198?
Both include esophageal biopsy, but 43193 uses a rigid transoral scope and 43198 uses a flexible transnasal scope.
Can a diagnostic or therapeutic endoscopy be billed in the same session?
When related endoscopies are performed together, CMS endoscopy family pricing applies. The record should support each service performed.
Is modifier 50 appropriate for 43193?
No. The anatomy or service descriptor makes bilateral adjustment inappropriate for this code.
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.
5,13143180,,Esophagoscopy rigid trnso,A,,8.80,4.23,NA,4.23,,1.31,14.34,14.34,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13243191,,Esophagoscopy rigid trnso dx,A,,2.43,1.26,NA,1.26,,0.37,4.06,4.06,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13343192,,Esophagoscp rig trnso inject,A,,2.72,1.28,NA,1.28,,0.40,4.40,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13443193,,Esophagoscp rig trnso biopsy,A,,2.72,1.30,NA,1.30,,0.41,4.43,4.43,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13543194,,Esophagoscp rig trnso rem fb,A,,3.42,0.94,NA,0.94,,0.48,4.84,4.84,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13643195,,Esophagoscopy rigid balloon,A,,2.99,1.35,NA,1.35,,0.43,4.77,4.77,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13743196,,Esophagoscp guide wire dilat,A,,3.23,1.46,NA,1.46,,0.45,5.14,5.14,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808