$203.48–$230.17
Choose 43198 when tissue is obtained by biopsy during flexible transnasal esophagoscopy. Choose 43197 for the transnasal diagnostic examination with brushing or washing collection.
On this page
CMS RVU26D · Effective 2026-10-01
43198 Esophageal biopsy Medicare reimbursement rates in Washington
Reports flexible transnasal esophagoscopy with biopsy when a physician samples esophageal tissue to evaluate suspected mucosal disease or an abnormality. Compare 43198 office and facility rates across CMS payment localities in Washington.
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 43198 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$224.86–$253.73
2 of 2 localities have a supported rate.
Facility setting
$81.37–$86.52
2 of 2 localities have a supported rate.
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.
Gastrointestinal endoscopy
About 43198: Transnasal flexible esophageal biopsy
Reports flexible transnasal esophagoscopy with biopsy when a physician samples esophageal tissue to evaluate suspected mucosal disease or an abnormality.
The physician advances a flexible endoscope through the nose into the esophagus and obtains tissue samples for examination. Otolaryngologists and other physicians trained in transnasal esophagoscopy may perform this service in an office or facility setting. It can be used to investigate symptoms such as dysphagia or to assess a visible or suspected esophageal abnormality when tissue diagnosis is needed.
Report 43198 for the transnasal flexible approach when biopsy is performed; the code includes single or multiple biopsies during the session. The procedure note should establish the route, esophageal findings, biopsy sites, and that tissue was obtained. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for it, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43198
- 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 RVU1.77 · 27%
- Practice expense (office) RVU4.51 · 69%
- Malpractice RVU0.25 · 4%
198
Medicare services in 2024 · #4335 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.
43198 compared with similar codes
Office rates for Washington, from the same CMS release.
No office rate
Both involve esophageal biopsy, but 43193 uses a rigid instrument passed transorally; 43198 uses a flexible instrument passed transnasally.
$409.67–$469.56
Both report flexible esophagoscopy with biopsy. Use 43198 for the transnasal route and 43202 for the transoral route.
Compare 43198 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.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
$224.86
Facility
$81.37
Seattle (King Cnty) →
Office / nonfacility
$253.73
Facility
$86.52
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43198 billing questions
How does 43198 differ from 43197?
43198 reports tissue biopsy during flexible transnasal esophagoscopy. 43197 is the transnasal flexible diagnostic service with specimen collection by brushing or washing.
Can multiple biopsy samples be billed as multiple units?
No. The code covers a single or multiple biopsies during the procedure; document the sampled sites and findings, but do not count each specimen as a separate unit of 43198.
How does 43198 differ from 43202?
Both include esophageal biopsy, but 43198 uses a transnasal approach and 43202 uses a transoral flexible approach. The documented route identifies the appropriate code.
Should modifier 50 be reported?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this esophageal procedure.
What happens when another related endoscopy is performed at the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. The procedure record should identify each service performed.
Is an assistant or co-surgeon payable?
Medicare does not pay an assistant at surgery for 43198. 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 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.
5,13643195,,Esophagoscopy rigid balloon,A,,2.99,1.35,NA,1.35,,0.43,4.77,4.77,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13743196,,Esophagoscp guide wire dilat,A,,3.23,1.46,NA,1.46,,0.45,5.14,5.14,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13843197,,Esophagoscopy flex dx brush,A,,1.48,4.21,,0.36,,0.21,5.90,2.05,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13943198,,Esophagosc flex trnsn biopsy,A,,1.77,4.51,,0.43,,0.25,6.53,2.45,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43197,33.4009,09,0,99,0.00,0.00,0.00
5,14043200,,Esophagoscopy flexible brush,A,,1.38,7.00,,0.79,,0.21,8.59,2.38,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,14143201,,Esoph scope w/submucous inj,A,,1.68,6.43,,0.86,,0.22,8.33,2.76,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14243202,,Esophagoscopy flex biopsy,A,,1.68,9.88,,0.90,,0.21,11.77,2.79,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00