Billing code 43212: Esophageal stentMedicare rate & RVUs in Guam
Flexible transoral esophagoscopy with stent placement treats an esophageal narrowing, obstruction, leak, or fistula when endoscopic support is needed.
CMS doesn’t publish an office rate for 43212 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 43212 covers
43212 reports flexible transoral endoscopy of the esophagus to deploy a stent across a significant narrowing or defect, such as an obstructing stricture or leak. Gastroenterologists and other physicians trained in therapeutic endoscopy perform it, commonly in a hospital or ambulatory endoscopy facility. The service includes guidewire passage and dilation before or after deployment when needed to place the stent; those steps are not separately reported as standalone dilation when integral to stent placement.
Select 43212 when a stent is placed through an esophagoscope. If the therapeutic examination extends through the stomach or duodenum as an EGD, consider 43266 instead. Document the indication, esophageal site, stent deployment, and any related guidewire or dilation steps. 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 not appropriate for this esophageal service. Medicare does not pay an assistant at surgery for this code; 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.
43212 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $168.22 |
How the 43212 rate is calculated
Each of 43212’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 · 43212
RVUs × geographic indexes × conversion factor
Work3.32
3.32 RVUs× 1.000 GPCI
Practice expense1.25
1.25 RVUs× 1.000 GPCI
Malpractice0.51
0.51 RVUs× 1.000 GPCI
Adjusted RVUs
5.0800
Conversion factor
$33.4009
Medicare rate
$169.68
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43212
The CMS indicators that decide how 43212 is paid alongside other services.
CMS payment indicators · 43212
Esophageal 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
43212 without 51 · national facility
$169.68
Esophageal stent
43212-51 · Second procedure: 50%
$84.84
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%).
43212 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43266Endoscopic stent
- 43212 is for stent placement through esophagoscopy. Use 43266 when the therapeutic examination is an EGD that includes the stomach or duodenum.
- 43220Esophageal dilation
- 43220 describes esophageal balloon dilation without stent placement. Choose 43212 when a stent is deployed, with associated dilation included when performed for placement.
- 43226Esophageal dilation
- 43226 is esophageal dilation without stent placement. 43212 requires actual stent deployment.
- 43214Esophageal dilation
- 43214 describes balloon dilation to 30 mm or greater, not stent placement. Report 43212 when the service includes deployment of an esophageal stent.
43212 billing questions
When should 43212 be chosen over 43266?
Use 43212 for stent placement through flexible esophagoscopy. Consider 43266 when the therapeutic examination is an EGD that includes the stomach or duodenum.
Can the guidewire passage or dilation be billed separately?
Guidewire passage and pre- or post-dilation are included when performed to place the stent. Do not separately report those integral steps as standalone dilation.
How are related endoscopies priced when performed in the same session?
CMS endoscopy-family pricing applies to related endoscopies performed together. Apply the family pricing rules to the same-session services rather than treating each as an unrelated procedure.
Should modifier 50 be appended for the esophagus?
No. Modifier 50 is inappropriate for this service; report the stent placement for the treated esophagus without bilateral reporting.
What documentation supports reporting 43212?
Document the esophageal indication and site, the stent deployment, and any guidewire passage or dilation performed as part of placement.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
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
Fee sheets
Put 43212 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →