Billing code 43193: EsophagoscopyMedicare rate & RVUs in Texas
Reports rigid transoral examination of the esophagus with tissue biopsy, commonly used to sample a visible lesion or abnormal mucosa.
CMS doesn’t publish an office rate for 43193 in Texas.
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 43193 covers
A rigid scope is passed through the mouth to examine the esophagus and obtain tissue from an area requiring histologic evaluation. Otolaryngologists and other surgeons may perform this procedure, often in a facility setting, when evaluating a suspicious mucosal lesion, abnormal tissue, or another finding that needs biopsy. The code includes the esophageal examination and biopsy sampling, whether one or multiple specimens are taken.
Select 43193 when tissue is sampled using a rigid transoral approach; a diagnostic examination without biopsy is a different service. The record should identify the approach, the esophageal finding, and the biopsy performed. 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. Bilateral adjustment is not appropriate. Medicare does not pay an assistant at surgery, 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 43193 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $149.10 |
| Beaumont | Unavailable | $143.09 |
| Brazoria | Unavailable | $145.29 |
| Dallas | Unavailable | $146.67 |
| Fort Worth | Unavailable | $146.41 |
| Galveston | Unavailable | $146.03 |
| Houston | Unavailable | $153.54 |
| Rest Of Texas | Unavailable | $144.42 |
How the 43193 rate is calculated
Each of 43193’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 · 43193
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.72Practice expense 1.30Malpractice 0.41
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43193
The CMS indicators that decide how 43193 is paid alongside other services.
CMS payment indicators · 43193
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 | 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
43193 without 51 · national facility
$147.97
Esophagoscopy
43193-51 · Second procedure: 50%
$73.99
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%).
43193 compared with similar codes
Compare codes
43193 vs 43191 vs 43198 vs 43192 vs 43194: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43191Esophagoscopy
- Both use a rigid transoral scope, but 43193 includes biopsy; 43191 is for diagnostic examination without biopsy.
- 43198Esophageal biopsy
- Both include esophageal biopsy. Choose 43193 for a rigid transoral approach and 43198 for a flexible transnasal approach.
- 43192Esophagoscopy
- 43192 describes injection during rigid transoral esophagoscopy, while 43193 describes biopsy.
- 43194Foreign body removal
- 43194 is used when the rigid transoral procedure removes a foreign body; 43193 is used when it obtains tissue for biopsy.
43193 billing questions
How does 43193 differ from 43191?
43193 includes biopsy with a rigid transoral esophagoscopy. Use 43191 for a rigid transoral diagnostic examination without biopsy.
Can multiple biopsy samples be reported as multiple units?
The code covers single or multiple biopsies during the procedure. Do not report a separate unit for each sample.
How does 43193 differ from 43198?
Both include esophageal biopsy, but 43193 uses a rigid transoral scope and 43198 uses a flexible transnasal scope.
Can a diagnostic or therapeutic endoscopy be billed in the same session?
When related endoscopies are performed together, CMS endoscopy family pricing applies. The record should support each service performed.
Is modifier 50 appropriate for 43193?
No. The anatomy or service descriptor makes bilateral adjustment inappropriate for this code.
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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