No office rate
Use 43241 for an intraluminal tube or catheter placed through the upper GI tract. Use 43246 when the endoscopist creates a gastrostomy and places a tube through the abdominal wall.
On this page
CMS RVU26D · Effective 2026-10-01
43241 Endoscopic tube placement Medicare reimbursement rates in Vermont
Report this service when an upper endoscopy is used to place an intraluminal tube or catheter, such as a nasoenteric feeding tube. Compare 43241 office and facility rates across CMS payment localities in Vermont.
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 43241 in Vermont?
Vermont 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
$121.62
1 of 1 localities have a supported rate.
Payment area: Vermont
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 43241: Upper endoscopy with tube placement
Report this service when an upper endoscopy is used to place an intraluminal tube or catheter, such as a nasoenteric feeding tube.
A gastroenterologist or other qualified endoscopist advances a flexible scope through the mouth to guide an intraluminal tube or catheter into the upper gastrointestinal tract. A common use is placing a nasoenteric feeding tube under direct visualization, including when blind advancement is unsuccessful or tube position needs endoscopic guidance. The procedure may be performed in a hospital or, less commonly, an office setting.
Choose this code when tube or catheter insertion is the therapeutic service, rather than simply inspecting the esophagus, stomach, and duodenum. The report should identify the indication, the tube or catheter placed, and the endoscopic guidance and placement performed. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 43241
- 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 RVU2.43 · 64%
- Practice expense (office) RVU1.07 · 28%
- Malpractice RVU0.30 · 8%
4.2K
Medicare services in 2024 · #1976 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.
43241 compared with similar codes
Office rates for Vermont, from the same CMS release.
$448.80
43241 captures tube or catheter placement. 43248 is for guidewire-assisted esophageal dilation, not simply advancing a tube under endoscopic guidance.
$316.23
43235 describes diagnostic upper endoscopy without the tube-placement service. When the endoscopy guides tube insertion, report the therapeutic service rather than separately reporting the diagnostic examination.
$411.07
43239 is for mucosal biopsy during EGD. Use 43241 when the service performed is placement of an intraluminal tube or catheter; document any separately performed biopsy.
Compare 43241 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
Vermont →
Office / nonfacility
Unavailable
Facility
$121.62
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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 43241 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,169
- Code
- 43241
- Physician work
- 2.43
- Practice expense
- 1.07
- Malpractice
- 0.30
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.43 | × 1.000 | 2.4300 |
| Practice expense | 1.07 | × 0.990 | 1.0593 |
| Malpractice | 0.30 | × 0.506 | 0.1518 |
| Total RVUs | 3.6411 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$121.62
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.43 | 1 |
| Practice expense | 1.07 | 0.99 |
| Malpractice | 0.3 | 0.506 |
(2.43 × 1 + 1.07 × 0.99 + 0.3 × 0.506) × $33.4009 = $121.62
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.
43241 billing questions
How is this different from gastrostomy tube placement?
This code covers endoscopic placement of an intraluminal tube or catheter through the upper gastrointestinal tract. Code 43246 describes endoscopic placement of a gastrostomy tube through the abdominal wall.
Can a diagnostic EGD also be reported?
The inspection performed as part of the tube-placement procedure is integral to that service. Do not separately report a diagnostic EGD code for the same examination.
What documentation supports reporting this code?
Document the clinical reason for placement, the type of tube or catheter, and how endoscopy was used to guide its placement. The record should distinguish tube placement from diagnostic examination alone.
Should modifier 50 be used for placement on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery billing are not permitted.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. Report the procedures supported by the operative note, with the applicable family pricing reflected in payment.
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.
5,16643238,,Egd us fine needle bx/aspir,A,,4.06,1.62,NA,1.62,,0.44,6.12,6.12,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16743239,,Egd biopsy single/multiple,A,,2.33,9.94,,1.10,,0.27,12.54,3.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16843240,,Egd w/transmural drain cyst,A,,6.97,2.48,NA,2.48,,0.79,10.24,10.24,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16943241,,Egd tube/cath insertion,A,,2.43,1.07,NA,1.07,,0.30,3.80,3.80,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17043242,,Egd us fine needle bx/aspir,A,,4.61,1.78,NA,1.78,,0.49,6.88,6.88,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17143243,,Egd injection varices,A,,4.16,1.57,NA,1.57,,0.53,6.26,6.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17243244,,Egd varices ligation,A,,4.29,1.69,NA,1.69,,0.47,6.45,6.45,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817