No office rate
Choose 43259 for diagnostic EUS without tissue acquisition. Choose 43238 when EUS-guided fine-needle sampling is performed.
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CMS RVU26D · Effective 2026-10-01
43259 Endoscopic ultrasound Medicare reimbursement rates in Kentucky
Reports upper gastrointestinal endoscopic ultrasound to assess the digestive tract wall and nearby structures, such as the pancreas, bile ducts, and lymph nodes. Compare 43259 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 43259 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
$191.66
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 endoscopy
About 43259: Upper gastrointestinal endoscopic ultrasound examination
Reports upper gastrointestinal endoscopic ultrasound to assess the digestive tract wall and nearby structures, such as the pancreas, bile ducts, and lymph nodes.
A gastroenterologist or other qualified endoscopist uses an ultrasound-equipped endoscope to examine the upper digestive tract and structures next to it. Typical indications include characterizing a subepithelial mass, evaluating a pancreatic lesion or cyst, assessing bile duct abnormalities, and staging nearby lymph nodes. The examination may cover the esophagus, stomach, and duodenum or jejunum as clinically appropriate, in a hospital outpatient department or endoscopy center.
Report 43259 for the diagnostic ultrasound examination without the separately coded EUS-guided tissue sampling or therapeutic maneuver. Document the indication, areas examined, ultrasound findings, and any sampling or intervention performed; when tissue is obtained under EUS guidance, consider the applicable sampling code, such as 43238. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies occur together, endoscopy-family pricing applies. Modifier 50 is inappropriate because the examination follows upper-GI anatomy rather than paired sides. Medicare payment is restricted for an assistant at surgery; co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 43259
- 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 RVU3.94 · 66%
- Practice expense (office) RVU1.58 · 27%
- Malpractice RVU0.43 · 7%
32.6K
Medicare services in 2024 · #940 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.
43259 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
43259 reports diagnostic ultrasound examination; 43253 describes an EUS-guided transmural injection or marking procedure.
No office rate
43259 uses ultrasound imaging of the upper-GI tract and adjacent structures. 43260 is an ERCP service involving endoscopic access to the biliary or pancreatic ducts.
Compare 43259 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
$191.66
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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 43259 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,186
- Code
- 43259
- Physician work
- 3.94
- Practice expense
- 1.58
- Malpractice
- 0.43
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.94 | × 1.000 | 3.9400 |
| Practice expense | 1.58 | × 0.889 | 1.4046 |
| Malpractice | 0.43 | × 0.915 | 0.3935 |
| Total RVUs | 5.7381 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$191.66
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.94 | 1 |
| Practice expense | 1.58 | 0.889 |
| Malpractice | 0.43 | 0.915 |
(3.94 × 1 + 1.58 × 0.889 + 0.43 × 0.915) × $33.4009 = $191.66
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.
43259 billing questions
When should 43259 be reported instead of 43238?
Use 43259 for diagnostic EUS without needle sampling. When EUS-guided tissue sampling is performed, 43238 describes the sampling service and includes the ultrasound examination.
Can a separate EGD service be billed with 43259?
The examination is performed endoscopically, and related endoscopies performed together are subject to endoscopy-family pricing. Document each service performed and follow the applicable family code selection.
Is modifier 50 appropriate for 43259?
No. The upper-GI examination follows digestive tract anatomy, not paired right and left sides.
What documentation supports 43259?
Record the clinical indication, anatomic regions examined, and ultrasound findings. Clearly identify any EUS-guided tissue sampling or therapeutic maneuver because it may require a different code.
Can an assistant, co-surgeon, or surgical team be reported?
Medicare payment is restricted for an assistant at surgery for this service. Co-surgeon and team-surgery reporting 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.
5,18343254,,Egd endo mucosal resection,A,,4.75,1.81,NA,1.81,,0.53,7.09,7.09,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18443255,,Egd control bleeding any,A,,3.47,16.77,,1.44,,0.39,20.63,5.30,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18543257,,Egd w/thrml txmnt gerd,A,,4.05,1.62,NA,1.62,,0.45,6.12,6.12,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18643259,,Egd us exam duodenum/jejunum,A,,3.94,1.58,NA,1.58,,0.43,5.95,5.95,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,1874325F,,Med txmnt options rvwd w/pt,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,18843260,,Ercp w/specimen collection,A,,5.70,2.09,NA,2.09,,0.62,8.41,8.41,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,18943261,,Endo cholangiopancreatograph,A,,6.00,2.18,NA,2.18,,0.67,8.85,8.85,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
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