No office rate
43237 describes upper GI endoscopic ultrasound examination. Choose 43240 when the physician also creates a transmural route and drains the collection.
On this page
CMS RVU26D · Effective 2026-10-01
43240 Pseudocyst drainage Medicare reimbursement rates in Kentucky
Report this service when an upper endoscope is used to create a drainage route through the stomach or duodenal wall for a pseudocyst. Compare 43240 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 43240 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
$330.59
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.
Gastrointestinal endoscopy
About 43240: Endoscopic pseudocyst drainage
Report this service when an upper endoscope is used to create a drainage route through the stomach or duodenal wall for a pseudocyst.
A gastroenterologist typically performs this procedure in a hospital or other facility for a pancreatic pseudocyst or similar collection that can be reached through the stomach or duodenum. Using an upper endoscope, the physician accesses the collection through the gastrointestinal wall and establishes drainage into the digestive tract, often with a stent. Endoscopic ultrasound may be used to locate the collection and guide access; the code covers the drainage service, not just imaging or needle sampling.
Report the code when the physician actually performs transmural drainage, and document the collection, access site, drainage performed, and any device placed. A diagnostic examination or aspiration for sampling alone does not establish that drainage was performed. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 43240
- 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 RVU6.97 · 68%
- Practice expense (office) RVU2.48 · 24%
- Malpractice RVU0.79 · 8%
1.3K
Medicare services in 2024 · #2776 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.
43240 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
43238 is for EUS-guided needle sampling. It does not describe therapeutic drainage through the stomach or duodenal wall.
No office rate
43242 describes EUS-guided fine-needle sampling; 43240 describes drainage of a pseudocyst rather than sampling for diagnosis.
No office rate
43253 covers EUS-guided transmural injection or marker placement. Use 43240 when the intervention is drainage of a pseudocyst.
Compare 43240 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
$330.59
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 43240 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,168
- Code
- 43240
- Physician work
- 6.97
- Practice expense
- 2.48
- Malpractice
- 0.79
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.97 | × 1.000 | 6.9700 |
| Practice expense | 2.48 | × 0.889 | 2.2047 |
| Malpractice | 0.79 | × 0.915 | 0.7229 |
| Total RVUs | 9.8976 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$330.59
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.97 | 1 |
| Practice expense | 2.48 | 0.889 |
| Malpractice | 0.79 | 0.915 |
(6.97 × 1 + 2.48 × 0.889 + 0.79 × 0.915) × $33.4009 = $330.59
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.
43240 billing questions
Does this code require actual drainage?
Yes. The physician must perform drainage through the gastrointestinal wall; imaging, inspection, or needle sampling alone is not this service.
Can an EUS examination be reported separately?
EUS may guide access, but this code describes the therapeutic drainage service. CMS endoscopy family pricing applies when related endoscopies are performed together.
How does this differ from EUS-guided needle sampling?
Use this code for therapeutic drainage of the collection. Needle sampling codes describe obtaining tissue or fluid for diagnostic evaluation rather than establishing drainage.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this service because of its descriptor or anatomy.
Can an assistant, co-surgeon, or surgical team be billed?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
What documentation supports reporting the service?
Document the pseudocyst or collection, its relationship to the stomach or duodenum, the transmural access, and the drainage performed. Include any stent or other device placed.
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.
5,16543237,,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
5,16843240,,Egd w/transmural drain cyst,A,,6.97,2.48,NA,2.48,,0.79,10.24,10.24,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16943241,,Egd tube/cath insertion,A,,2.43,1.07,NA,1.07,,0.30,3.80,3.80,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17043242,,Egd us fine needle bx/aspir,A,,4.61,1.78,NA,1.78,,0.49,6.88,6.88,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17143243,,Egd injection varices,A,,4.16,1.57,NA,1.57,,0.53,6.26,6.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
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