Billing code 43237: Endoscopic ultrasoundMedicare rate & RVUs in Illinois
Upper gastrointestinal endoscopic ultrasound evaluates the esophageal, gastric, or duodenal wall and nearby structures when imaging beyond standard endoscopy is needed.
CMS doesn’t publish an office rate for 43237 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 43237 covers
A gastroenterologist advances an endoscope with an ultrasound probe to assess the wall of the esophagus, stomach, or duodenum and adjacent structures. Common reasons include evaluating a subepithelial lesion, assessing wall layers, or examining nearby lymph nodes or pancreaticobiliary structures that are within the scope of the study. The service is performed in an endoscopy unit, ambulatory surgery center, or hospital facility.
Report this code when the EUS examination is limited to the specified upper gastrointestinal region and no EUS-guided needle aspiration or biopsy is performed. Document the indication, anatomic extent, structures examined, findings, and any sampling performed; needle sampling changes the code selection. 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, and CMS does not pay an assistant at surgery, co-surgeons, or a team of surgeons for this service.
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 43237 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 | $190.48 |
| East St. Louis | Unavailable | $182.09 |
| Rest Of Illinois | Unavailable | $176.04 |
| Suburban Chicago | Unavailable | $184.89 |
How the 43237 rate is calculated
Each of 43237’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 · 43237
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.38Practice expense 1.42Malpractice 0.38
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43237
The CMS indicators that decide how 43237 is paid alongside other services.
CMS payment indicators · 43237
Endoscopic ultrasound
| 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
43237 without 51 · national facility
$173.02
Endoscopic ultrasound
43237-51 · Second procedure: 50%
$86.51
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%).
43237 compared with similar codes
Compare codes
43237 vs 43238 vs 43259 vs 43231 vs 43239: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43238EUS-guided biopsy
- 43237 is for the limited EUS examination without EUS-guided needle sampling. Choose 43238 when the applicable EGD/EUS service includes needle aspiration or biopsy.
- 43259Endoscopic ultrasound
- 43237 is limited to the specified upper gastrointestinal region. 43259 describes an EUS examination with a broader anatomic extent.
- 43231Esophageal EUS
- 43231 uses esophagoscopy for an EUS examination limited to the esophagus; 43237 is the EGD-based service for the specified upper GI regions.
- 43239EGD with biopsy
- 43239 covers conventional mucosal biopsy during EGD. It is not the code for EUS-guided needle sampling of a lesion.
43237 billing questions
When should 43237 be used instead of 43238?
Use 43237 for the limited EUS examination without EUS-guided needle aspiration or biopsy. When needle sampling is performed, use the applicable sampling code, such as 43238.
Can the diagnostic EGD be billed separately with 43237?
The endoscopic access and examination needed to perform the EUS are part of the service. Do not separately report a diagnostic EGD for that same examination.
How does 43237 differ from 43259?
43237 describes an examination limited to the esophagus, stomach, or duodenum and adjacent structures. Use 43259 when the examination includes the broader anatomic extent specified for that code.
Should modifier 50 be appended for bilateral findings?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.
What documentation supports reporting 43237?
Document why EUS was needed, the anatomic region examined, the structures assessed, and the findings. State whether needle aspiration or biopsy occurred, since that affects code selection.
Are assistant surgeon or co-surgeon services payable with 43237?
CMS does not pay an assistant at surgery for this service and does not permit co-surgeons or team surgery.
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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