No office rate
43243 is specific to injection treatment of esophageal varices. Use 43236 for other directed submucosal injections, such as lesion marking or lifting.
On this page
CMS RVU26D · Effective 2026-10-01
43236 Submucosal injection Medicare reimbursement rates in Illinois
Reports upper GI endoscopy with directed injection into the submucosa, such as tattooing a lesion or lifting it for endoscopic treatment. Compare 43236 office and facility rates across CMS payment localities in Illinois.
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 43236 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
$420.05–$463.45
4 of 4 localities have a supported rate.
Facility setting
$125.46–$135.99
4 of 4 localities have a supported rate.
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.
Where 43236 pays more and less in Illinois
4 payment localities
$420.05 to $463.45
Gastroenterology
About 43236: Upper GI endoscopy with submucosal injection
Reports upper GI endoscopy with directed injection into the submucosa, such as tattooing a lesion or lifting it for endoscopic treatment.
During an upper GI endoscopy, the physician directs a substance into the submucosal layer of the esophagus, stomach, or duodenum. Common purposes include placing tattoo ink to help locate a lesion later or injecting a lifting solution beneath a lesion before endoscopic treatment. Gastroenterologists and other physicians who perform upper endoscopy may provide the service in an office endoscopy suite or a hospital outpatient endoscopy unit.
Select this code when the procedure documentation supports directed submucosal injection, not merely diagnostic inspection or tissue sampling. Record the injection site, substance, purpose, endoscopic findings, and any other intervention 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-surgeons and team surgery are not permitted.
CMS billing rules for 43236
- 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 RVU2.33 · 17%
- Practice expense (office) RVU10.76 · 81%
- Malpractice RVU0.27 · 2%
13.8K
Medicare services in 2024 · #1297 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.
43236 compared with similar codes
Office rates for Illinois, from the same CMS release.
$395.04–$435.32
43239 reports upper GI endoscopic biopsy; 43236 reports injection into the submucosa. The services have different purposes even when performed during one EGD.
$305.72–$335.97
43235 describes diagnostic upper GI endoscopy with specimen collection by brushing or washing. It does not describe directed submucosal injection.
No office rate
43244 treats esophageal varices by ligation. It is distinct from injection of a substance into the submucosa.
Compare 43236 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
$460.26
Facility
$135.99
East St. Louis →
Office / nonfacility
$426.63
Facility
$129.79
Rest Of Illinois →
Office / nonfacility
$420.05
Facility
$125.46
Suburban Chicago →
Office / nonfacility
$463.45
Facility
$132.08
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43236 billing questions
When should this code be chosen instead of 43243?
Use 43236 for directed submucosal injection such as lesion marking or lifting. Code 43243 describes injection treatment of esophageal varices.
Is the code reported once for each injection site?
The code describes the endoscopic injection service, including one or more injections. Documentation should identify the treated site or sites and the purpose.
Can biopsy or lesion removal also be reported?
The injection service is distinct from tissue sampling or lesion removal, but same-session reporting depends on applicable coding edits. CMS endoscopy-family pricing applies when related endoscopies are performed together.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant, co-surgeon, or surgical team be paid?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery 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.
5,16143232,,Esophagoscopy w/us needle bx,A,,3.50,1.42,NA,1.42,,0.39,5.31,5.31,0,000,0.00,0.00,0.00,3,0,1,2,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,16243233,,Egd balloon dil esoph30 mm/>,A,,3.97,1.52,NA,1.52,,0.62,6.11,6.11,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16343235,,Egd diagnostic brush wash,A,,2.04,7.38,,1.03,,0.24,9.66,3.31,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,16443236,,Uppr gi scope w/submuc inj,A,,2.33,10.76,,1.10,,0.27,13.36,3.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16543237,,Endoscopic us exam esoph,A,,3.38,1.42,NA,1.42,,0.38,5.18,5.18,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16643238,,Egd us fine needle bx/aspir,A,,4.06,1.62,NA,1.62,,0.44,6.12,6.12,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16743239,,Egd biopsy single/multiple,A,,2.33,9.94,,1.10,,0.27,12.54,3.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00