Billing code 43241: Endoscopic tube placementMedicare rate & RVUs in Guam
Report this service when an upper endoscopy is used to place an intraluminal tube or catheter, such as a nasoenteric feeding tube.
CMS doesn’t publish an office rate for 43241 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 43241 covers
A gastroenterologist or other qualified endoscopist advances a flexible scope through the mouth to guide an intraluminal tube or catheter into the upper gastrointestinal tract. A common use is placing a nasoenteric feeding tube under direct visualization, including when blind advancement is unsuccessful or tube position needs endoscopic guidance. The procedure may be performed in a hospital or, less commonly, an office setting.
Choose this code when tube or catheter insertion is the therapeutic service, rather than simply inspecting the esophagus, stomach, and duodenum. The report should identify the indication, the tube or catheter placed, and the endoscopic guidance and placement performed. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery, 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.
43241 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $127.60 |
How the 43241 rate is calculated
Each of 43241’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 · 43241
RVUs × geographic indexes × conversion factor
Work2.43
2.43 RVUs× 1.000 GPCI
Practice expense1.07
1.07 RVUs× 1.000 GPCI
Malpractice0.30
0.30 RVUs× 1.000 GPCI
Adjusted RVUs
3.8000
Conversion factor
$33.4009
Medicare rate
$126.92
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43241
The CMS indicators that decide how 43241 is paid alongside other services.
CMS payment indicators · 43241
Endoscopic tube placement
| 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
43241 without 51 · national facility
$126.92
Endoscopic tube placement
43241-51 · Second procedure: 50%
$63.46
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%).
43241 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43246PEG placement
- Use 43241 for an intraluminal tube or catheter placed through the upper GI tract. Use 43246 when the endoscopist creates a gastrostomy and places a tube through the abdominal wall.
- 43248Esophageal dilation
- 43241 captures tube or catheter placement. 43248 is for guidewire-assisted esophageal dilation, not simply advancing a tube under endoscopic guidance.
- 43235Upper GI endoscopy
- 43235 describes diagnostic upper endoscopy without the tube-placement service. When the endoscopy guides tube insertion, report the therapeutic service rather than separately reporting the diagnostic examination.
- 43239EGD with biopsy
- 43239 is for mucosal biopsy during EGD. Use 43241 when the service performed is placement of an intraluminal tube or catheter; document any separately performed biopsy.
43241 billing questions
How is this different from gastrostomy tube placement?
This code covers endoscopic placement of an intraluminal tube or catheter through the upper gastrointestinal tract. Code 43246 describes endoscopic placement of a gastrostomy tube through the abdominal wall.
Can a diagnostic EGD also be reported?
The inspection performed as part of the tube-placement procedure is integral to that service. Do not separately report a diagnostic EGD code for the same examination.
What documentation supports reporting this code?
Document the clinical reason for placement, the type of tube or catheter, and how endoscopy was used to guide its placement. The record should distinguish tube placement from diagnostic examination alone.
Should modifier 50 be used for placement on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery billing are not permitted.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. Report the procedures supported by the operative note, with the applicable family pricing reflected in payment.
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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