$202.90–$213.67
Both use a flexible transnasal approach. Choose 43197 for diagnostic examination with brushing or washing; 43198 describes biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
43197 Esophagoscopy Medicare reimbursement rates in Maine
Flexible transnasal esophagoscopy examines the esophagus for diagnostic purposes and includes specimen collection by brushing or washing when performed. Compare 43197 office and facility rates across CMS payment localities in Maine.
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 43197 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$183.16–$193.21
2 of 2 localities have a supported rate.
Facility setting
$64.86–$65.78
2 of 2 localities have a supported rate.
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.
GI endoscopy
About 43197: Flexible transnasal diagnostic esophagoscopy with brushing
Flexible transnasal esophagoscopy examines the esophagus for diagnostic purposes and includes specimen collection by brushing or washing when performed.
A physician passes a flexible endoscope through the nose to inspect the esophagus. The diagnostic examination may include collecting cells or material by brushing or washing. Otolaryngologists commonly perform transnasal esophagoscopy in an office or outpatient setting to evaluate symptoms such as dysphagia or a sensation of something in the throat.
Report 43197 when the approach is transnasal and the service is diagnostic; brushing or washing is included when performed. The procedure note should support the route, examination, findings, and any specimen collection. A tissue sample obtained by biopsy points to 43198 instead. This code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is not appropriate for this esophageal examination. Medicare does not pay for an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 43197
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- 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 RVU1.48 · 25%
- Practice expense (office) RVU4.21 · 71%
- Malpractice RVU0.21 · 4%
978
Medicare services in 2024 · #2985 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.
43197 compared with similar codes
Office rates for Maine, from the same CMS release.
$265.56–$282.22
Both are diagnostic flexible esophagoscopies that may include brushing or washing. The key distinction is transnasal access for 43197 versus transoral access for 43200.
$364.08–$387.57
43202 is flexible and transoral, with biopsy. 43197 is flexible and transnasal, with diagnostic brushing or washing when performed.
Compare 43197 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
$183.16
Facility
$64.86
Southern Maine →
Office / nonfacility
$193.21
Facility
$65.78
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.
43197 billing questions
When should 43197 be used instead of 43198?
Use 43197 for diagnostic transnasal esophagoscopy with brushing or washing when performed. A tissue sample obtained by biopsy is the distinguishing service for 43198.
Is brushing or washing separately reported?
No. Specimen collection by brushing or washing is included in 43197 when performed.
How does 43197 differ from 43200?
Both describe diagnostic flexible esophagoscopy with brushing or washing when performed, but 43197 uses a transnasal route and 43200 uses a transoral route.
What documentation supports 43197?
Document the transnasal route, diagnostic examination of the esophagus, findings, and whether brushing or washing was performed.
How are other same-session procedures paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard 50% multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay for an assistant at surgery for this code. Co-surgeon and team-surgery billing 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.
5,13543194,,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
5,13743196,,Esophagoscp guide wire dilat,A,,3.23,1.46,NA,1.46,,0.45,5.14,5.14,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13843197,,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