Billing code 43197: EsophagoscopyMedicare rate & RVUs in Ohio
Flexible transnasal esophagoscopy examines the esophagus for diagnostic purposes and includes specimen collection by brushing or washing when performed.
Medicare pays $184.89 for 43197 in the office in Ohio (Ohio). 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 43197 covers
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.
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 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $184.89 | $67.48 |
How the 43197 rate is calculated
Each of 43197’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 · 43197
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.48Practice expense 4.21Malpractice 0.21
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43197
The CMS indicators that decide how 43197 is paid alongside other services.
CMS payment indicators · 43197
Esophagoscopy
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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
43197 without 51 · national office
$197.07
Esophagoscopy
43197-51 · Second procedure: 50%
$98.54
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%).
43197 compared with similar codes
Compare codes
43197 vs 43198 vs 43200 vs 43202: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43198Esophageal biopsy
- Both use a flexible transnasal approach. Choose 43197 for diagnostic examination with brushing or washing; 43198 describes biopsy.
- 43200Esophagoscopy
- Both are diagnostic flexible esophagoscopies that may include brushing or washing. The key distinction is transnasal access for 43197 versus transoral access for 43200.
- 43202Esophageal biopsy
- 43202 is flexible and transoral, with biopsy. 43197 is flexible and transnasal, with diagnostic brushing or washing when performed.
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 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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