Billing code 43240: Pseudocyst drainageMedicare rate & RVUs in Guam
Report this service when an upper endoscope is used to create a drainage route through the stomach or duodenal wall for a pseudocyst.
CMS doesn’t publish an office rate for 43240 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 43240 covers
A gastroenterologist typically performs this procedure in a hospital or other facility for a pancreatic pseudocyst or similar collection that can be reached through the stomach or duodenum. Using an upper endoscope, the physician accesses the collection through the gastrointestinal wall and establishes drainage into the digestive tract, often with a stent. Endoscopic ultrasound may be used to locate the collection and guide access; the code covers the drainage service, not just imaging or needle sampling.
Report the code when the physician actually performs transmural drainage, and document the collection, access site, drainage performed, and any device placed. A diagnostic examination or aspiration for sampling alone does not establish that drainage was performed. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service, and 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.
43240 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $342.26 |
How the 43240 rate is calculated
Each of 43240’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 · 43240
RVUs × geographic indexes × conversion factor
Work6.97
6.97 RVUs× 1.000 GPCI
Practice expense2.48
2.48 RVUs× 1.000 GPCI
Malpractice0.79
0.79 RVUs× 1.000 GPCI
Adjusted RVUs
10.2400
Conversion factor
$33.4009
Medicare rate
$342.03
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43240
The CMS indicators that decide how 43240 is paid alongside other services.
CMS payment indicators · 43240
Pseudocyst drainage
| 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
43240 without 51 · national facility
$342.03
Pseudocyst drainage
43240-51 · Second procedure: 50%
$171.02
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%).
43240 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43237Endoscopic ultrasound
- 43237 describes upper GI endoscopic ultrasound examination. Choose 43240 when the physician also creates a transmural route and drains the collection.
- 43238EUS-guided biopsy
- 43238 is for EUS-guided needle sampling. It does not describe therapeutic drainage through the stomach or duodenal wall.
- 43242EUS-guided biopsy
- 43242 describes EUS-guided fine-needle sampling; 43240 describes drainage of a pseudocyst rather than sampling for diagnosis.
- 43253EUS-guided procedure
- 43253 covers EUS-guided transmural injection or marker placement. Use 43240 when the intervention is drainage of a pseudocyst.
43240 billing questions
Does this code require actual drainage?
Yes. The physician must perform drainage through the gastrointestinal wall; imaging, inspection, or needle sampling alone is not this service.
Can an EUS examination be reported separately?
EUS may guide access, but this code describes the therapeutic drainage service. CMS endoscopy family pricing applies when related endoscopies are performed together.
How does this differ from EUS-guided needle sampling?
Use this code for therapeutic drainage of the collection. Needle sampling codes describe obtaining tissue or fluid for diagnostic evaluation rather than establishing drainage.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this service because of its descriptor or anatomy.
Can an assistant, co-surgeon, or surgical team be billed?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
What documentation supports reporting the service?
Document the pseudocyst or collection, its relationship to the stomach or duodenum, the transmural access, and the drainage performed. Include any stent or other device placed.
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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