No office rate
43212 is for stent placement through esophagoscopy. Use 43266 when the therapeutic examination is an EGD that includes the stomach or duodenum.
On this page
CMS RVU26D · Effective 2026-10-01
43212 Esophageal stent Medicare reimbursement rates in Ohio
Flexible transoral esophagoscopy with stent placement treats an esophageal narrowing, obstruction, leak, or fistula when endoscopic support is needed. Compare 43212 office and facility rates across CMS payment localities in Ohio.
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 43212 in Ohio?
Ohio 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
$166.18
1 of 1 localities have a supported rate.
Payment area: Ohio
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 43212: Flexible esophagoscopy with stent placement
Flexible transoral esophagoscopy with stent placement treats an esophageal narrowing, obstruction, leak, or fistula when endoscopic support is needed.
43212 reports flexible transoral endoscopy of the esophagus to deploy a stent across a significant narrowing or defect, such as an obstructing stricture or leak. Gastroenterologists and other physicians trained in therapeutic endoscopy perform it, commonly in a hospital or ambulatory endoscopy facility. The service includes guidewire passage and dilation before or after deployment when needed to place the stent; those steps are not separately reported as standalone dilation when integral to stent placement.
Select 43212 when a stent is placed through an esophagoscope. If the therapeutic examination extends through the stomach or duodenum as an EGD, consider 43266 instead. Document the indication, esophageal site, stent deployment, and any related guidewire or dilation steps. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Endoscopy-family pricing applies when related endoscopies are performed together. Modifier 50 is not appropriate for this esophageal service. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 43212
- 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 RVU3.32 · 65%
- Practice expense (office) RVU1.25 · 25%
- Malpractice RVU0.51 · 10%
495
Medicare services in 2024 · #3573 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.
43212 compared with similar codes
Office rates for Ohio, from the same CMS release.
$881.09
43220 describes esophageal balloon dilation without stent placement. Choose 43212 when a stent is deployed, with associated dilation included when performed for placement.
$386.53
43226 is esophageal dilation without stent placement. 43212 requires actual stent deployment.
No office rate
43214 describes balloon dilation to 30 mm or greater, not stent placement. Report 43212 when the service includes deployment of an esophageal stent.
Compare 43212 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
Ohio →
Office / nonfacility
Unavailable
Facility
$166.18
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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 43212 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
5,149
- Code
- 43212
- Physician work
- 3.32
- Practice expense
- 1.25
- Malpractice
- 0.51
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.32 | × 1.000 | 3.3200 |
| Practice expense | 1.25 | × 0.913 | 1.1413 |
| Malpractice | 0.51 | × 1.008 | 0.5141 |
| Total RVUs | 4.9753 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Ohio$166.18
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.32 | 1 |
| Practice expense | 1.25 | 0.913 |
| Malpractice | 0.51 | 1.008 |
(3.32 × 1 + 1.25 × 0.913 + 0.51 × 1.008) × $33.4009 = $166.18
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.
43212 billing questions
When should 43212 be chosen over 43266?
Use 43212 for stent placement through flexible esophagoscopy. Consider 43266 when the therapeutic examination is an EGD that includes the stomach or duodenum.
Can the guidewire passage or dilation be billed separately?
Guidewire passage and pre- or post-dilation are included when performed to place the stent. Do not separately report those integral steps as standalone dilation.
How are related endoscopies priced when performed in the same session?
CMS endoscopy-family pricing applies to related endoscopies performed together. Apply the family pricing rules to the same-session services rather than treating each as an unrelated procedure.
Should modifier 50 be appended for the esophagus?
No. Modifier 50 is inappropriate for this service; report the stent placement for the treated esophagus without bilateral reporting.
What documentation supports reporting 43212?
Document the esophageal indication and site, the stent deployment, and any guidewire passage or dilation performed as part of placement.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
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.
5,1464320F,,Pt talk psychsoc&rx oh dpnd,I,,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
5,14743210,,Egd esophagogastrc fndoplsty,A,,7.56,2.70,NA,2.70,,1.10,11.36,11.36,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,14843211,,Esophagoscop mucosal resect,A,,4.10,1.64,NA,1.64,,0.45,6.19,6.19,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14943212,,Esophagoscop stent placement,A,,3.32,1.25,NA,1.25,,0.51,5.08,5.08,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15043213,,Esophagoscopy retro balloon,A,,4.51,32.37,,1.57,,0.67,37.55,6.75,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15143214,,Esophagosc dilate balloon 30,A,,3.32,1.22,NA,1.22,,0.50,5.04,5.04,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15243215,,Esophagoscopy flex remove fb,A,,2.38,10.33,,1.08,,0.36,13.07,3.82,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703