Billing code 43238: EUS-guided biopsyMedicare rate & RVUs in Delaware
Reports upper endoscopy with ultrasound-guided needle sampling of a lesion in the upper GI wall or an adjacent structure during a limited examination.
CMS doesn’t publish an office rate for 43238 in Delaware.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 43238 covers
A gastroenterologist performs this service by passing an endoscope through the mouth and using endoscopic ultrasound to guide a needle into a target for aspiration or tissue sampling. Typical targets include a subepithelial stomach lesion, a pancreatic mass, or a suspicious lymph node near the upper gastrointestinal tract. The service is commonly performed in a hospital endoscopy unit or ambulatory endoscopy setting when imaging and tissue acquisition are needed during the same procedure.
Choose 43238 when the EUS examination is limited to the relevant portion of the esophagus, stomach, or duodenum and adjacent structures, and needle sampling is performed. The report should identify the target, ultrasound-guided sampling, and the extent of the examination; the code includes the EUS examination and sampling, rather than a separately billed diagnostic EUS. 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. Modifier 50 is inappropriate for this anatomy. CMS does not pay an assistant at surgery and does not permit co-surgeon or team-surgery billing for this service.
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.
43238 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $202.96 |
How the 43238 rate is calculated
Each of 43238’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43238
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.06Practice expense 1.62Malpractice 0.44
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43238
The CMS indicators that decide how 43238 is paid alongside other services.
CMS payment indicators · 43238
EUS-guided biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43238 without 51 · national facility
$204.41
EUS-guided biopsy
43238-51 · Second procedure: 50%
$102.21
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43238 compared with similar codes
Compare codes
43238 vs 43242 vs 43237 vs 43239 vs 43232: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43242EUS-guided biopsy
- Both codes include EUS-guided needle sampling. Choose 43238 for a limited upper-GI examination and 43242 when the examination includes the esophagus, stomach, and duodenum with adjacent structures.
- 43237Endoscopic ultrasound
- 43237 describes EUS examination without needle sampling. When EUS guides aspiration or biopsy during the procedure, 43238 captures the examination and sampling together.
- 43239EGD with biopsy
- 43239 is for endoscopic biopsy of mucosa. Choose 43238 when the endoscopist uses ultrasound to guide a needle into a wall lesion or adjacent target.
- 43232Esophageal EUS
- 43232 is the esophagoscopy-based EUS needle-sampling service for an examination limited to the esophagus; 43238 is the EGD-based service for the specified upper-GI examination.
43238 billing questions
How does 43238 differ from 43242?
Both include EUS-guided needle sampling. 43238 is for a limited upper-GI EUS examination; 43242 describes examination of the esophagus, stomach, and duodenum with adjacent structures.
Can the diagnostic EUS be billed separately?
The EUS examination that guides the sampling is included in 43238. Do not separately report 43237 for that same examination.
When is 43239 a better fit?
Use 43239 for standard endoscopic biopsy of gastrointestinal mucosa. 43238 is for needle sampling guided by EUS, such as sampling a deeper wall lesion or an adjacent structure.
Does each needle pass count as a separate unit?
The code covers the endoscopic service with needle aspiration or biopsy sampling; it is not reported once for each needle pass.
Is modifier 50 appropriate?
No. The anatomy is not reported as a bilateral service, so modifier 50 is inappropriate.
Can an assistant or co-surgeon be billed?
CMS does not pay an assistant at surgery for this service and does not permit co-surgeon or team-surgery billing.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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