Billing code 43235: Upper GI endoscopyMedicare rate & RVUs in Oklahoma
Reports a flexible upper endoscopic examination of the esophagus, stomach, and duodenum, including brush or wash cytology when performed without biopsy or therapy.
Medicare pays $294.49 for 43235 in the office in Oklahoma (Oklahoma). 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 43235 covers
A flexible scope is passed through the mouth to examine the esophagus, stomach, and duodenum. When performed, brushings or washings collect cells or material for laboratory analysis; they are part of this service. Gastroenterologists and other physicians trained in upper endoscopy perform it in office, ambulatory, and hospital settings to evaluate upper gastrointestinal symptoms or findings when the examination is diagnostic.
Report this code when inspection, with or without brushings or washings, is performed without a biopsy or therapeutic intervention. The record should support the examined anatomy, findings, and any sampled site and method. A biopsy or endoscopic treatment calls for the corresponding procedure code rather than separate reporting of this diagnostic examination. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate; assistant-at-surgery services are not paid, 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.
43235 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | $294.49 | $105.09 |
How the 43235 rate is calculated
Each of 43235’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 · 43235
RVUs × geographic indexes × conversion factor
Work2.04
2.04 RVUs× 1.000 GPCI
Practice expense7.38
7.38 RVUs× 1.000 GPCI
Malpractice0.24
0.24 RVUs× 1.000 GPCI
Adjusted RVUs
9.6600
Conversion factor
$33.4009
Medicare rate
$322.65
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43235
The CMS indicators that decide how 43235 is paid alongside other services.
CMS payment indicators · 43235
Upper GI endoscopy
| 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
43235 without 51 · national office
$322.65
Upper GI endoscopy
43235-51 · Second procedure: 50%
$161.33
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%).
43235 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43239EGD with biopsy
- 43235 covers diagnostic inspection with brushings or washings when performed. Choose 43239 when forceps biopsy is performed during the upper endoscopy.
- 43237Endoscopic ultrasound
- 43237 includes endoscopic ultrasound examination. Choose 43235 for diagnostic inspection without the ultrasound service.
- 43245EGD dilation
- 43245 includes dilation of a stricture during upper endoscopy. 43235 is for diagnostic examination without that therapeutic work.
43235 billing questions
When should 43239 be reported instead?
Use 43239 when forceps biopsy is performed during the upper endoscopy. Do not separately report this diagnostic examination for the same session.
Are brushings or washings separately billable?
No. Brushings or washings, when performed as part of the diagnostic examination, are included in 43235.
Can 43235 be reported with an endoscopic treatment?
When the same session includes a therapeutic upper endoscopic procedure, report the procedure performed rather than separately reporting the diagnostic examination.
Should modifier 50 be appended?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
How does Medicare handle multiple procedures in one session?
The highest-valued procedure is paid in full; other procedures in the same session are paid at 50%. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be billed for this procedure?
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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