Billing code 43266: Endoscopic stentMedicare rate & RVUs in Delaware
Report upper GI endoscopic stent placement when an endoscopist deploys a stent to maintain luminal patency or seal a leak during transoral EGD.
CMS doesn’t publish an office rate for 43266 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 43266 covers
During flexible transoral EGD, the endoscopist advances and deploys a stent to maintain patency or seal a leak in the upper gastrointestinal tract. Typical cases include palliation of an obstructing esophageal tumor and endoscopic treatment of a selected luminal narrowing or leak. Gastroenterologists and therapeutic endoscopists perform this service in a hospital or ambulatory endoscopy facility.
Report 43266 for stent deployment; the service includes guidewire passage and pre- or post-dilation when performed. The record should identify the target, indication, stent placement, and any dilation performed. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
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.
43266 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $190.82 |
How the 43266 rate is calculated
Each of 43266’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 · 43266
RVUs × geographic indexes × conversion factor
Work3.82
3.82 RVUs× 1.000 GPCI
Practice expense1.46
1.46 RVUs× 1.000 GPCI
Malpractice0.48
0.48 RVUs× 1.000 GPCI
Adjusted RVUs
5.7600
Conversion factor
$33.4009
Medicare rate
$192.39
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43266
The CMS indicators that decide how 43266 is paid alongside other services.
CMS payment indicators · 43266
Endoscopic stent
| 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
43266 without 51 · national facility
$192.39
Endoscopic stent
43266-51 · Second procedure: 50%
$96.20
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%).
43266 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43248Esophageal dilation
- 43248 is used for guidewire-assisted esophageal dilation without endoscopic stent deployment. Dilation performed as part of 43266 is included in that service.
- 43249Esophageal dilation
- 43249 describes balloon dilation of the esophagus, not placement of an endoscopic stent. Choose 43266 when a stent is deployed.
- 43274ERCP stenting
- 43274 is an ERCP service for stent placement in a bile or pancreatic duct; 43266 is for stent placement during transoral EGD.
43266 billing questions
Is dilation separately reported when it is performed to place the stent?
Pre- and post-dilation, along with guidewire passage when performed, are included in 43266. Do not separately report those steps as stand-alone services.
How is 43266 different from ERCP stent placement?
43266 describes stent placement during transoral EGD in the upper GI tract. Use the ERCP stent code when the stent is placed in a bile or pancreatic duct through ERCP.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The claim should reflect the procedures actually performed and documented.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 43266, and co-surgeons and team surgery are not permitted.
What documentation supports reporting 43266?
Document the clinical target and reason for stenting, the stent deployment, and any dilation performed. The record should distinguish stent placement from evaluation or dilation alone.
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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