Billing code 43191: EsophagoscopyMedicare rate & RVUs in Guam
Reports rigid esophageal examination through the mouth for diagnostic evaluation, including specimen collection by brushing or washing when performed.
CMS doesn’t publish an office rate for 43191 in Guam.
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 43191 covers
An otolaryngologist or other qualified physician passes a rigid endoscope through the mouth to inspect the esophagus for problems such as dysphagia, suspected mucosal abnormality, or narrowing. The service is commonly performed in a procedural or operating-room setting. Brushing or washing to collect specimens is included when performed; this code describes diagnostic examination rather than endoscopic biopsy or treatment such as foreign-body removal.
Select this code when the documented approach is rigid and transoral and the service is diagnostic. The operative or procedure note should identify the route and instrument, the area examined, and any brushing or washing performed. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Medicare does not pay an assistant-at-surgery claim for this service; co-surgeon and team-surgery billing 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.
43191 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $136.17 |
How the 43191 rate is calculated
Each of 43191’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 · 43191
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.43Practice expense 1.26Malpractice 0.37
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43191
The CMS indicators that decide how 43191 is paid alongside other services.
CMS payment indicators · 43191
Esophagoscopy
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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
43191 without 51 · national facility
$135.61
Esophagoscopy
43191-51 · Second procedure: 50%
$67.81
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%).
43191 compared with similar codes
Compare codes
43191 vs 43193 vs 43197 vs 43200 vs 43194: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43193Esophagoscopy
- Choose 43193 when the rigid transoral examination includes biopsy. Brushing or washing alone remains within 43191.
- 43197Esophagoscopy
- 43197 describes diagnostic examination with a flexible scope passed transnasally; 43191 is rigid and transoral.
- 43200Esophagoscopy
- 43200 is the diagnostic flexible transoral esophagoscopy alternative; 43191 uses a rigid transoral scope.
- 43194Foreign body removal
- 43194 describes rigid transoral esophagoscopy with foreign-body removal, rather than diagnostic examination alone.
43191 billing questions
When should 43191 be selected instead of 43193?
Use 43191 for diagnostic rigid transoral examination, including brushing or washing when performed. Use 43193 when the rigid examination includes biopsy.
Are brushing and washing separately reported?
No. Specimen collection by brushing or washing is included in 43191 when performed.
How does 43191 differ from 43197?
Both describe diagnostic esophageal examination with possible brushing or washing, but 43191 uses a rigid transoral scope and 43197 uses a flexible transnasal scope.
Can 43191 be reported with a foreign-body removal code?
If the rigid esophagoscopy includes removal of a foreign body, consider 43194 rather than reporting the diagnostic code for that same service.
What same-session payment rules affect 43191?
Medicare includes same-day preoperative and postoperative care in its 0-day global period. With multiple procedures in one session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
Can an assistant or co-surgeon be billed for 43191?
Medicare does not pay an assistant-at-surgery claim for this service. Co-surgeon and team-surgery billing 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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