No office rate
Choose 43191 for rigid transoral diagnostic examination without injection. Choose 43192 when injection is performed during that examination.
On this page
CMS RVU26D · Effective 2026-10-01
43192 Esophagoscopy Medicare reimbursement rates in Kentucky
Reports rigid transoral esophagoscopy with therapeutic injection, such as targeted botulinum toxin treatment for upper esophageal sphincter dysfunction. Compare 43192 office and facility rates across CMS payment localities in Kentucky.
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 43192 in Kentucky?
Kentucky 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
No supported rate
Facility setting
$141.08
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Gastroenterology
About 43192: Rigid transoral esophagoscopy with injection
Reports rigid transoral esophagoscopy with therapeutic injection, such as targeted botulinum toxin treatment for upper esophageal sphincter dysfunction.
The physician passes a rigid endoscope through the mouth to examine the esophagus and deliver one or more injections at a targeted site. Otolaryngologists commonly perform this procedure in an operating room, including for selected patients with cricopharyngeal or upper esophageal sphincter dysfunction receiving botulinum toxin. The operative report should identify the scope approach, injection site, agent, and therapeutic purpose.
Report this code when injection is performed during rigid transoral esophagoscopy; a diagnostic examination alone, tissue sampling, foreign-body removal, or dilation represents a different service. The injection code covers the injection work during the procedure, so do not assign additional units solely for multiple injection sites in the same session. CMS assigns a 0-day global period, including same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate; assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43192
- 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 RVU2.72 · 62%
- Practice expense (office) RVU1.28 · 29%
- Malpractice RVU0.40 · 9%
252
Medicare services in 2024 · #4135 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.
43192 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
43193 reports biopsy during rigid transoral esophagoscopy; 43192 reports injection. The operative note should support which intervention occurred.
$253.77
Both involve injection during esophagoscopy, but 43201 uses a flexible transoral scope and 43192 uses a rigid transoral scope.
No office rate
43195 is for balloon dilation during rigid transoral esophagoscopy. It is not the injection code.
Compare 43192 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$141.08
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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 43192 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,133
- Code
- 43192
- Physician work
- 2.72
- Practice expense
- 1.28
- Malpractice
- 0.40
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.72 | × 1.000 | 2.7200 |
| Practice expense | 1.28 | × 0.889 | 1.1379 |
| Malpractice | 0.40 | × 0.915 | 0.3660 |
| Total RVUs | 4.2239 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$141.08
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.72 | 1 |
| Practice expense | 1.28 | 0.889 |
| Malpractice | 0.4 | 0.915 |
(2.72 × 1 + 1.28 × 0.889 + 0.4 × 0.915) × $33.4009 = $141.08
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.
43192 billing questions
How does this differ from 43191?
43191 describes rigid transoral esophagoscopy for diagnostic examination. Use 43192 when the physician performs injection during the rigid examination.
How does this differ from 43193?
43193 is the rigid transoral esophagoscopy code for biopsy. Injection is the distinguishing service for 43192; report the procedure actually documented.
Can multiple injection sites be billed as multiple units?
The code includes injection or injections performed during the rigid esophagoscopy. Do not increase units solely because the physician injects more than one site in the same procedure.
Is 43201 interchangeable with this code?
No. 43201 describes injection during flexible transoral esophagoscopy; 43192 is for the rigid transoral approach.
What should the operative note document?
Document the rigid transoral approach, the site and purpose of the injection, and the agent administered. The code has a 0-day global period, and modifier 50 is inappropriate.
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.
5,13043135,,Removal of esophagus pouch,A,,25.52,9.62,NA,9.62,,6.43,41.57,41.57,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13143180,,Esophagoscopy rigid trnso,A,,8.80,4.23,NA,4.23,,1.31,14.34,14.34,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13243191,,Esophagoscopy rigid trnso dx,A,,2.43,1.26,NA,1.26,,0.37,4.06,4.06,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13343192,,Esophagoscp rig trnso inject,A,,2.72,1.28,NA,1.28,,0.40,4.40,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13443193,,Esophagoscp rig trnso biopsy,A,,2.72,1.30,NA,1.30,,0.41,4.43,4.43,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13543194,,Esophagoscp rig trnso rem fb,A,,3.42,0.94,NA,0.94,,0.48,4.84,4.84,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13643195,,Esophagoscopy rigid balloon,A,,2.99,1.35,NA,1.35,,0.43,4.77,4.77,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631