Billing code 43201: EsophagoscopyMedicare rate & RVUs in Washington
Flexible esophagoscopy with targeted injection into the esophageal submucosa, such as botulinum toxin treatment at the lower esophageal sphincter.
Medicare pays $288.59–$328.44 for 43201 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 43201 covers
A flexible scope is passed through the mouth to examine the esophagus while a needle delivers medication or another substance into its submucosal layer. A familiar use is injecting botulinum toxin near the lower esophageal sphincter to treat achalasia. Gastroenterologists and other physicians trained in endoscopy perform the procedure in settings such as a hospital outpatient department or ambulatory surgery center.
Report the esophagus-only injection service when the endoscopic treatment involves directed submucosal injection. The note should identify the injection site, substance, and therapeutic purpose, along with the endoscopic findings. 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, 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 43201 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $288.59 | $92.68 |
| Seattle (King Cnty) | $328.44 | $100.17 |
How the 43201 rate is calculated
Each of 43201’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 · 43201
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.68Practice expense 6.43Malpractice 0.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43201
The CMS indicators that decide how 43201 is paid alongside other services.
CMS payment indicators · 43201
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
43201 without 51 · national office
$278.23
Esophagoscopy
43201-51 · Second procedure: 50%
$139.12
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%).
43201 compared with similar codes
Compare codes
43201 vs 43204 vs 43236 vs 43202 vs 43200: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43204Variceal injection
- Choose 43204 when the esophageal injection is for sclerosis. This code describes directed submucosal injection of another substance, such as botulinum toxin.
- 43236Submucosal injection
- Choose 43236 for submucosal injection during the broader upper-GI endoscopy service. This code is for the esophagus-only endoscopic injection service.
- 43202Esophageal biopsy
- 43202 is the esophagoscopy code for biopsy. Use this code when the service is directed submucosal injection instead.
- 43200Esophagoscopy
- 43200 describes diagnostic flexible esophagoscopy. This code applies when the examination includes directed submucosal injection.
43201 billing questions
When is this code a better fit than 43204?
Use this code for directed submucosal injection of a substance such as botulinum toxin. Code 43204 describes esophageal injection for sclerosis, such as treatment directed at varices.
How does this differ from 43236?
This code describes injection during esophagoscopy limited to the esophagus. Code 43236 describes injection during an upper gastrointestinal endoscopy that includes the broader upper-GI examination specified by that code.
Can a diagnostic examination be reported separately?
The endoscopic examination is part of the injection service. If related endoscopies are performed together, CMS endoscopy-family pricing applies.
What documentation supports the injection service?
Document the esophageal site, injected substance, reason for treatment, and endoscopic findings. For example, identify the lower esophageal sphincter when treating achalasia with botulinum toxin.
Should modifier 50 be appended for treatment on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's 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 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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