Billing code 43236: Submucosal injectionMedicare rate & RVUs in Massachusetts
Reports upper GI endoscopy with directed injection into the submucosa, such as tattooing a lesion or lifting it for endoscopic treatment.
Medicare pays $464.70–$518.16 for 43236 in the office in Massachusetts, from Rest Of Massachusetts to Metropolitan Boston. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 43236 covers
During an upper GI endoscopy, the physician directs a substance into the submucosal layer of the esophagus, stomach, or duodenum. Common purposes include placing tattoo ink to help locate a lesion later or injecting a lifting solution beneath a lesion before endoscopic treatment. Gastroenterologists and other physicians who perform upper endoscopy may provide the service in an office endoscopy suite or a hospital outpatient endoscopy unit.
Select this code when the procedure documentation supports directed submucosal injection, not merely diagnostic inspection or tissue sampling. Record the injection site, substance, purpose, endoscopic findings, and any other intervention performed. 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; Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
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.
Where 43236 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | $518.16 | $132.91 |
| Rest Of Massachusetts | $464.70 | $124.95 |
How the 43236 rate is calculated
Each of 43236’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43236
RVUs × geographic indexes × conversion factor
Work2.33
2.33 RVUs× 1.000 GPCI
Practice expense10.76
10.76 RVUs× 1.000 GPCI
Malpractice0.27
0.27 RVUs× 1.000 GPCI
Adjusted RVUs
13.3600
Conversion factor
$33.4009
Medicare rate
$446.24
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43236
The CMS indicators that decide how 43236 is paid alongside other services.
CMS payment indicators · 43236
Submucosal injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43236 without 51 · national office
$446.24
Submucosal injection
43236-51 · Second procedure: 50%
$223.12
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43236 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43243Variceal injection
- 43243 is specific to injection treatment of esophageal varices. Use 43236 for other directed submucosal injections, such as lesion marking or lifting.
- 43239EGD with biopsy
- 43239 reports upper GI endoscopic biopsy; 43236 reports injection into the submucosa. The services have different purposes even when performed during one EGD.
- 43235Upper GI endoscopy
- 43235 describes diagnostic upper GI endoscopy with specimen collection by brushing or washing. It does not describe directed submucosal injection.
- 43244Variceal ligation
- 43244 treats esophageal varices by ligation. It is distinct from injection of a substance into the submucosa.
43236 billing questions
When should this code be chosen instead of 43243?
Use 43236 for directed submucosal injection such as lesion marking or lifting. Code 43243 describes injection treatment of esophageal varices.
Is the code reported once for each injection site?
The code describes the endoscopic injection service, including one or more injections. Documentation should identify the treated site or sites and the purpose.
Can biopsy or lesion removal also be reported?
The injection service is distinct from tissue sampling or lesion removal, but same-session reporting depends on applicable coding edits. CMS endoscopy-family pricing applies when related endoscopies are performed together.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant, co-surgeon, or surgical team be paid?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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