No office rate
Choose 43193 when the rigid transoral examination includes biopsy. Brushing or washing alone remains within 43191.
On this page
CMS RVU26D · Effective 2026-10-01
43191 Esophagoscopy Medicare reimbursement rates in Hawaii
Reports rigid esophageal examination through the mouth for diagnostic evaluation, including specimen collection by brushing or washing when performed. Compare 43191 office and facility rates across CMS payment localities in Hawaii.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 43191 in Hawaii?
Hawaii has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$136.17
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Endoscopy
About 43191: Rigid transoral diagnostic esophagoscopy
Reports rigid esophageal examination through the mouth for diagnostic evaluation, including specimen collection by brushing or washing when performed.
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.
CMS billing rules for 43191
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.43 · 60%
- Practice expense (office) RVU1.26 · 31%
- Malpractice RVU0.37 · 9%
2.1K
Medicare services in 2024 · #2415 by national volume
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 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$213.38
43197 describes diagnostic examination with a flexible scope passed transnasally; 43191 is rigid and transoral.
$315.99
43200 is the diagnostic flexible transoral esophagoscopy alternative; 43191 uses a rigid transoral scope.
No office rate
43194 describes rigid transoral esophagoscopy with foreign-body removal, rather than diagnostic examination alone.
Compare 43191 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$136.17
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43191 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,132
- Code
- 43191
- Physician work
- 2.43
- Practice expense
- 1.26
- Malpractice
- 0.37
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.43 | × 1.000 | 2.4300 |
| Practice expense | 1.26 | × 1.137 | 1.4326 |
| Malpractice | 0.37 | × 0.579 | 0.2142 |
| Total RVUs | 4.0769 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$136.17
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.43 | 1 |
| Practice expense | 1.26 | 1.137 |
| Malpractice | 0.37 | 0.579 |
(2.43 × 1 + 1.26 × 1.137 + 0.37 × 0.579) × $33.4009 = $136.17
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,12943130,,Removal of esophagus pouch,A,,12.22,6.95,NA,6.95,,2.22,21.39,21.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13043135,,Removal of esophagus pouch,A,,25.52,9.62,NA,9.62,,6.43,41.57,41.57,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13143180,,Esophagoscopy rigid trnso,A,,8.80,4.23,NA,4.23,,1.31,14.34,14.34,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13243191,,Esophagoscopy rigid trnso dx,A,,2.43,1.26,NA,1.26,,0.37,4.06,4.06,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13343192,,Esophagoscp rig trnso inject,A,,2.72,1.28,NA,1.28,,0.40,4.40,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13443193,,Esophagoscp rig trnso biopsy,A,,2.72,1.30,NA,1.30,,0.41,4.43,4.43,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13543194,,Esophagoscp rig trnso rem fb,A,,3.42,0.94,NA,0.94,,0.48,4.84,4.84,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014