CPT code 43259: Endoscopic ultrasound2026 Medicare rate & RVUs in Florida
Reports upper gastrointestinal endoscopic ultrasound to assess the digestive tract wall and nearby structures, such as the pancreas, bile ducts, and lymph nodes.
CMS doesn’t publish an office rate for 43259 in Florida.
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 43259 covers
A gastroenterologist or other qualified endoscopist uses an ultrasound-equipped endoscope to examine the upper digestive tract and structures next to it. Typical indications include characterizing a subepithelial mass, evaluating a pancreatic lesion or cyst, assessing bile duct abnormalities, and staging nearby lymph nodes. The examination may cover the esophagus, stomach, and duodenum or jejunum as clinically appropriate, in a hospital outpatient department or endoscopy center.
Report 43259 for the diagnostic ultrasound examination without the separately coded EUS-guided tissue sampling or therapeutic maneuver. Document the indication, areas examined, ultrasound findings, and any sampling or intervention performed; when tissue is obtained under EUS guidance, consider the applicable sampling code, such as 43238. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies occur together, endoscopy-family pricing applies. Modifier 50 is inappropriate because the examination follows upper-GI anatomy rather than paired sides. Medicare payment is restricted for an assistant at surgery; co-surgeon and team-surgery reporting 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.
Where 43259 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $211.03 |
| Miami | Unavailable | $222.86 |
| Rest Of Florida | Unavailable | $203.64 |
How the 43259 rate is calculated
Each of 43259’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 · 43259
RVUs × geographic indexes × conversion factor
Work3.94
3.94 RVUs× 1.000 GPCI
Practice expense1.58
1.58 RVUs× 1.000 GPCI
Malpractice0.43
0.43 RVUs× 1.000 GPCI
Adjusted RVUs
5.9500
Conversion factor
$33.4009
Medicare rate
$198.74
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43259
The CMS indicators that decide how 43259 is paid alongside other services.
CMS payment indicators · 43259
Endoscopic ultrasound
| 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
43259 without 51 · national facility
$198.74
Endoscopic ultrasound
43259-51 · Second procedure: 50%
$99.37
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%).
43259 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43238EUS-guided biopsy
- Choose 43259 for diagnostic EUS without tissue acquisition. Choose 43238 when EUS-guided fine-needle sampling is performed.
- 43253EUS-guided procedure
- 43259 reports diagnostic ultrasound examination; 43253 describes an EUS-guided transmural injection or marking procedure.
- 43260ERCP
- 43259 uses ultrasound imaging of the upper-GI tract and adjacent structures. 43260 is an ERCP service involving endoscopic access to the biliary or pancreatic ducts.
43259 billing questions
When should 43259 be reported instead of 43238?
Use 43259 for diagnostic EUS without needle sampling. When EUS-guided tissue sampling is performed, 43238 describes the sampling service and includes the ultrasound examination.
Can a separate EGD service be billed with 43259?
The examination is performed endoscopically, and related endoscopies performed together are subject to endoscopy-family pricing. Document each service performed and follow the applicable family code selection.
Is modifier 50 appropriate for 43259?
No. The upper-GI examination follows digestive tract anatomy, not paired right and left sides.
What documentation supports 43259?
Record the clinical indication, anatomic regions examined, and ultrasound findings. Clearly identify any EUS-guided tissue sampling or therapeutic maneuver because it may require a different code.
Can an assistant, co-surgeon, or surgical team be reported?
Medicare payment is restricted for an assistant at surgery for this service. Co-surgeon and team-surgery reporting are not permitted.
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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