$315.99
Choose 43202 for forceps tissue sampling. Choose 43200 when the esophageal specimen is collected by brushing for cytology.
On this page
CMS RVU26D · Effective 2026-10-01
43202 Esophageal biopsy Medicare reimbursement rates in Hawaii
Flexible esophagoscopy with forceps sampling of esophageal tissue is reported when examination is confined to the esophagus and tissue diagnosis is needed. Compare 43202 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 43202 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
$435.39
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$94.35
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.
Gastrointestinal endoscopy
About 43202: Flexible esophageal biopsy endoscopy
Flexible esophagoscopy with forceps sampling of esophageal tissue is reported when examination is confined to the esophagus and tissue diagnosis is needed.
A flexible scope is passed through the mouth to inspect the esophagus, and tissue is collected for examination, typically with biopsy forceps. Gastroenterologists and other physicians trained in endoscopy may perform it in an office or an endoscopy facility. Common reasons include sampling an abnormal esophageal area, such as inflamed or suspicious mucosa. The service includes one or multiple biopsies during the examination.
Choose this code when the procedure is limited to the esophagus; if the examination extends into the stomach or duodenum, select the applicable upper endoscopy code instead. Document the esophageal findings, biopsy location, and sampling performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 43202
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- 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 RVU1.68 · 14%
- Practice expense (office) RVU9.88 · 84%
- Malpractice RVU0.21 · 2%
2.4K
Medicare services in 2024 · #2343 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.
43202 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
43202 samples accessible esophageal mucosa with routine biopsy technique; 43232 uses endoscopic ultrasound guidance for needle sampling.
$353.05
43202 is limited to esophagoscopy with tissue biopsy. 43235 is an upper endoscopy service when the examination includes the stomach or duodenum.
No office rate
43202 takes tissue samples for diagnosis. 43211 removes esophageal mucosa as a therapeutic resection rather than performing a routine biopsy.
Compare 43202 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
$435.39
Facility
$94.35
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 43202 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,142
- Code
- 43202
- Physician work
- 1.68
- Practice expense
- 9.88
- Malpractice
- 0.21
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.68 | × 1.000 | 1.6800 |
| Practice expense | 9.88 | × 1.137 | 11.2336 |
| Malpractice | 0.21 | × 0.579 | 0.1216 |
| Total RVUs | 13.0351 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$435.39
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.68 | 1 |
| Practice expense | 9.88 | 1.137 |
| Malpractice | 0.21 | 0.579 |
(1.68 × 1 + 9.88 × 1.137 + 0.21 × 0.579) × $33.4009 = $435.39
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.68 | 1 |
| Practice expense | 0.9 | 1.137 |
| Malpractice | 0.21 | 0.579 |
(1.68 × 1 + 0.9 × 1.137 + 0.21 × 0.579) × $33.4009 = $94.35
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.
43202 billing questions
How is this different from code 43200?
Code 43202 involves tissue biopsy, generally collected with forceps. Code 43200 describes esophageal brushing for cytology rather than forceps tissue sampling.
Can a separate biopsy code be reported for the same esophageal samples?
The biopsy is included in this service. Do not separately report another biopsy service for the same sampling.
When should an EGD code be selected instead?
Use an applicable EGD code when the examination includes the stomach or duodenum. This code is for examination and biopsy confined to the esophagus.
How does CMS price related endoscopies performed in the same session?
CMS applies endoscopy-family pricing when related endoscopies are performed together. The 0-day global period includes same-day preoperative and postoperative care.
Which surgical modifiers are appropriate?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, and 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.
5,13943198,,Esophagosc flex trnsn biopsy,A,,1.77,4.51,,0.43,,0.25,6.53,2.45,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43197,33.4009,09,0,99,0.00,0.00,0.00
5,14043200,,Esophagoscopy flexible brush,A,,1.38,7.00,,0.79,,0.21,8.59,2.38,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,14143201,,Esoph scope w/submucous inj,A,,1.68,6.43,,0.86,,0.22,8.33,2.76,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14243202,,Esophagoscopy flex biopsy,A,,1.68,9.88,,0.90,,0.21,11.77,2.79,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14343204,,Esoph scope w/sclerosis inj,A,,2.27,1.09,NA,1.09,,0.25,3.61,3.61,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14443205,,Esophagus endoscopy/ligation,A,,2.38,1.13,NA,1.13,,0.26,3.77,3.77,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14543206,,Esoph optical endomicroscopy,A,,2.23,7.72,,1.08,,0.24,10.19,3.55,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
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