Billing code 43231: Esophageal EUSMedicare rate & RVUs in Ohio
Reports transoral flexible esophagoscopy with endoscopic ultrasound confined to the esophagus, such as assessment of an esophageal lesion or wall thickening.
CMS doesn’t publish an office rate for 43231 in Ohio.
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 43231 covers
A gastroenterologist or other qualified physician passes a flexible endoscope through the mouth and uses ultrasound to examine structures in or adjacent to the esophagus. Typical uses include assessing an esophageal subepithelial lesion, wall thickening, or local tumor involvement. The ultrasound examination must be confined to the esophagus; this is not the code for an EUS-guided needle sample.
Select this service based on the documented scope and extent of the ultrasound examination, not simply the patient’s diagnosis. The report should identify the esophageal findings and support that EUS was performed. When related endoscopies are performed together, CMS endoscopy family pricing adjusts payment for the combined services. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery; co-surgeons are permitted, while team surgery is not.
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.
43231 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $134.73 |
How the 43231 rate is calculated
Each of 43231’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 · 43231
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.73Practice expense 1.13Malpractice 0.27
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43231
The CMS indicators that decide how 43231 is paid alongside other services.
CMS payment indicators · 43231
Esophageal EUS
| 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) | 2 | 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
43231 without 51 · national facility
$137.95
Esophageal EUS
43231-51 · Second procedure: 50%
$68.98
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%).
43231 compared with similar codes
Compare codes
43231 vs 43232 vs 43237 vs 43238: national Medicare rates
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How to choose
- 43232Esophageal EUS
- Choose 43231 for esophageal EUS without needle sampling. Choose 43232 when the esophageal EUS includes transendoscopic fine needle aspiration or biopsy.
- 43237Endoscopic ultrasound
- 43231 is confined to esophagoscopy and esophageal EUS. 43237 describes an EGD-based EUS examination that may include the stomach or duodenum as appropriate.
- 43238EUS-guided biopsy
- 43238 is an EGD-based EUS service with guided needle sampling; 43231 is an examination-only esophageal EUS service.
43231 billing questions
When should 43231 be chosen over 43237?
Use 43231 when flexible esophagoscopy with EUS is confined to the esophagus. Use 43237 for an EGD-based EUS examination that includes the stomach or duodenum as appropriate.
How does 43231 differ from 43232?
43231 describes an esophageal EUS examination without needle sampling. 43232 is for esophageal EUS-guided fine needle aspiration or biopsy.
Can EUS-guided needle sampling be reported with 43231?
When EUS-guided sampling is performed, consider the sampling code that matches the scope and anatomic extent, such as 43232 for esophageal esophagoscopy. The documentation should show the sampling service performed.
How are related endoscopies paid when performed together?
CMS endoscopy family pricing adjusts payment when related endoscopies are performed in the same session. Report the services supported by the procedure documentation.
Does 43231 have a global period or bilateral adjustment?
It has a 0-day global period, with same-day preoperative and postoperative care included. Modifier 50 is inappropriate for this service.
Can an assistant or additional surgeons be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeons are permitted, but team surgery is not.
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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