Billing code 43232: Esophageal EUSMedicare rate & RVUs in Illinois
Reports flexible esophagoscopy with ultrasound-guided needle sampling of tissue or a lesion in the esophageal wall or nearby structures.
CMS doesn’t publish an office rate for 43232 in Illinois.
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 43232 covers
A gastroenterologist passes a flexible endoscope through the mouth to examine the esophagus and uses endoscopic ultrasound to guide a needle into tissue for aspiration or biopsy. Typical targets include an esophageal subepithelial lesion or a mediastinal lymph node or mass accessible from the esophagus. The service is generally performed in a procedural endoscopy setting; it is distinct from sampling performed during an examination that continues into the stomach or duodenum.
Report this code when the record supports both esophagoscopy and ultrasound-guided intramural or transmural needle sampling. Document the examination extent, ultrasound findings, target, and needle sampling performed; multiple needle passes are part of the sampling service, not separate units per pass. The code has 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. CMS permits co-surgeons, does not permit team surgery, and does not pay an assistant at surgery.
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.
Where 43232 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $195.28 |
| East St. Louis | Unavailable | $186.77 |
| Rest Of Illinois | Unavailable | $180.57 |
| Suburban Chicago | Unavailable | $189.51 |
How the 43232 rate is calculated
Each of 43232’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 · 43232
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.50Practice expense 1.42Malpractice 0.39
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43232
The CMS indicators that decide how 43232 is paid alongside other services.
CMS payment indicators · 43232
Esophageal EUS
| 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) | 2 | 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
43232 without 51 · national facility
$177.36
Esophageal EUS
43232-51 · Second procedure: 50%
$88.68
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%).
43232 compared with similar codes
Compare codes
43232 vs 43231 vs 43238 vs 43239: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43231Esophageal EUS
- 43231 covers esophageal EUS examination without needle sampling. Choose 43232 when the endoscopist also performs ultrasound-guided needle aspiration or biopsy.
- 43238EUS-guided biopsy
- 43238 is the EGD-route code for EUS-guided needle sampling. Use 43232 for sampling performed through an esophagoscopy focused on the esophagus.
- 43239EGD with biopsy
- 43239 reports EGD with mucosal biopsy. 43232 applies when a needle is guided by endoscopic ultrasound to sample tissue within or beyond the esophageal wall.
43232 billing questions
When should this be chosen instead of 43231?
Use 43232 when ultrasound-guided needle aspiration or biopsy is performed. 43231 describes esophagoscopy with ultrasound examination without needle sampling.
How does this differ from an EGD with EUS-guided sampling?
43232 describes an esophagoscopy service focused on the esophagus and targets accessible from it. When the endoscopic examination and sampling are performed through an EGD route, consider the applicable EGD sampling code, such as 43238.
Are multiple needle passes reported as separate units?
No. The needle sampling is reported as the procedure, not as a separate unit for each pass. Document the target and sampling performed.
Can modifier 50 be used for bilateral sampling?
No. CMS identifies bilateral adjustment as inappropriate for this code, even when targets are sampled on both sides.
How does CMS handle related endoscopies performed together?
CMS endoscopy family pricing applies when related endoscopies are performed together. The code also has a 0-day global period, which includes same-day preoperative and postoperative care.
Can an assistant or another surgeon be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeons are permitted, while team surgery is 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 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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