No office rate
Choose 43231 for esophageal EUS without needle sampling. Choose 43232 when the esophageal EUS includes transendoscopic fine needle aspiration or biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
43231 Esophageal EUS Medicare reimbursement rates in Utah
Reports transoral flexible esophagoscopy with endoscopic ultrasound confined to the esophagus, such as assessment of an esophageal lesion or wall thickening. Compare 43231 office and facility rates across CMS payment localities in Utah.
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 43231 in Utah?
Utah 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
$134.76
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Gastroenterology endoscopy
About 43231: Esophageal endoscopic ultrasound examination
Reports transoral flexible esophagoscopy with endoscopic ultrasound confined to the esophagus, such as assessment of an esophageal lesion or wall thickening.
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.
CMS billing rules for 43231
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.73 · 66%
- Practice expense (office) RVU1.13 · 27%
- Malpractice RVU0.27 · 7%
541
Medicare services in 2024 · #3485 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.
43231 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
43231 is confined to esophagoscopy and esophageal EUS. 43237 describes an EGD-based EUS examination that may include the stomach or duodenum as appropriate.
No office rate
43238 is an EGD-based EUS service with guided needle sampling; 43231 is an examination-only esophageal EUS service.
Compare 43231 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
Utah →
Office / nonfacility
Unavailable
Facility
$134.76
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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 43231 in Utah.
PPRRVU2026_Oct_nonQPP.csv
5,160
- Code
- 43231
- Physician work
- 2.73
- Practice expense
- 1.13
- Malpractice
- 0.27
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.73 | × 1.000 | 2.7300 |
| Practice expense | 1.13 | × 0.940 | 1.0622 |
| Malpractice | 0.27 | × 0.898 | 0.2425 |
| Total RVUs | 4.0347 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$134.76
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.73 | 1 |
| Practice expense | 1.13 | 0.94 |
| Malpractice | 0.27 | 0.898 |
(2.73 × 1 + 1.13 × 0.94 + 0.27 × 0.898) × $33.4009 = $134.76
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.
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 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.
5,15743227,,Esophagoscopy control bleed,A,,2.82,16.44,,1.22,,0.36,19.62,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15843229,,Esophagoscopy lesion ablate,A,,3.40,19.60,,1.42,,0.41,23.41,5.23,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,1594322F,,Crgvr prov w/ ed addl rsrcs,M,,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
5,16043231,,Esophagoscop ultrasound exam,A,,2.73,1.13,NA,1.13,,0.27,4.13,4.13,0,000,0.00,0.00,0.00,3,0,1,2,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,16143232,,Esophagoscopy w/us needle bx,A,,3.50,1.42,NA,1.42,,0.39,5.31,5.31,0,000,0.00,0.00,0.00,3,0,1,2,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,16243233,,Egd balloon dil esoph30 mm/>,A,,3.97,1.52,NA,1.52,,0.62,6.11,6.11,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16343235,,Egd diagnostic brush wash,A,,2.04,7.38,,1.03,,0.24,9.66,3.31,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985