No office rate
Choose 43204 when the esophageal injection is for sclerosis. This code describes directed submucosal injection of another substance, such as botulinum toxin.
On this page
CMS RVU26D · Effective 2026-10-01
43201 Esophagoscopy Medicare reimbursement rates in Indiana
Flexible esophagoscopy with targeted injection into the esophageal submucosa, such as botulinum toxin treatment at the lower esophageal sphincter. Compare 43201 office and facility rates across CMS payment localities in Indiana.
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 43201 in Indiana?
Indiana 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
$258.77
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$86.31
1 of 1 localities have a supported rate.
Payment area: Indiana
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 43201: Esophagoscopy with submucosal injection
Flexible esophagoscopy with targeted injection into the esophageal submucosa, such as botulinum toxin treatment at the lower esophageal sphincter.
A flexible scope is passed through the mouth to examine the esophagus while a needle delivers medication or another substance into its submucosal layer. A familiar use is injecting botulinum toxin near the lower esophageal sphincter to treat achalasia. Gastroenterologists and other physicians trained in endoscopy perform the procedure in settings such as a hospital outpatient department or ambulatory surgery center.
Report the esophagus-only injection service when the endoscopic treatment involves directed submucosal injection. The note should identify the injection site, substance, and therapeutic purpose, along with the endoscopic findings. 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 for this service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43201
- 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 · 20%
- Practice expense (office) RVU6.43 · 77%
- Malpractice RVU0.22 · 3%
179
Medicare services in 2024 · #4429 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.
43201 compared with similar codes
Office rates for Indiana, from the same CMS release.
$415.36
Choose 43236 for submucosal injection during the broader upper-GI endoscopy service. This code is for the esophagus-only endoscopic injection service.
$365.43
43202 is the esophagoscopy code for biopsy. Use this code when the service is directed submucosal injection instead.
$266.24
43200 describes diagnostic flexible esophagoscopy. This code applies when the examination includes directed submucosal injection.
Compare 43201 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
Indiana →
Office / nonfacility
$258.77
Facility
$86.31
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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 43201 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,141
- Code
- 43201
- Physician work
- 1.68
- Practice expense
- 6.43
- Malpractice
- 0.22
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.68 | × 1.000 | 1.6800 |
| Practice expense | 6.43 | × 0.927 | 5.9606 |
| Malpractice | 0.22 | × 0.486 | 0.1069 |
| Total RVUs | 7.7475 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$258.77
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.68 | 1 |
| Practice expense | 6.43 | 0.927 |
| Malpractice | 0.22 | 0.486 |
(1.68 × 1 + 6.43 × 0.927 + 0.22 × 0.486) × $33.4009 = $258.77
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.68 | 1 |
| Practice expense | 0.86 | 0.927 |
| Malpractice | 0.22 | 0.486 |
(1.68 × 1 + 0.86 × 0.927 + 0.22 × 0.486) × $33.4009 = $86.31
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.
43201 billing questions
When is this code a better fit than 43204?
Use this code for directed submucosal injection of a substance such as botulinum toxin. Code 43204 describes esophageal injection for sclerosis, such as treatment directed at varices.
How does this differ from 43236?
This code describes injection during esophagoscopy limited to the esophagus. Code 43236 describes injection during an upper gastrointestinal endoscopy that includes the broader upper-GI examination specified by that code.
Can a diagnostic examination be reported separately?
The endoscopic examination is part of the injection service. If related endoscopies are performed together, CMS endoscopy-family pricing applies.
What documentation supports the injection service?
Document the esophageal site, injected substance, reason for treatment, and endoscopic findings. For example, identify the lower esophageal sphincter when treating achalasia with botulinum toxin.
Should modifier 50 be appended for treatment on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's payment.
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.
5,13843197,,Esophagoscopy flex dx brush,A,,1.48,4.21,,0.36,,0.21,5.90,2.05,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13943198,,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
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915