CPT 43201
Global 000 ActiveEsoph scope w/submucous inj
CPT 43201 Billing & Documentation Guide
CPT code 43201 (Esoph scope w/submucous inj) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.68, a non-facility practice expense RVU of 6.43, and a malpractice RVU of 0.22, a total non-facility RVU of 8.33 and facility RVU of 2.76. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $287.69, though rates vary from $244.38 to $375.92 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43201, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 43201 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 43201 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 43201
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.68 | 1.68 |
| Practice Expense RVU | 6.43 | 0.86 |
| Malpractice RVU | 0.22 | 0.22 |
| Total RVU | 8.33 | 2.76 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43201
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $316.24 | $96.1 | $296.39 - $375.92 | 29 |
| Florida | $285.9 | $99.24 | $272.48 - $298.27 | 3 |
| Georgia | $269.88 | $92.4 | $256.45 - $283.31 | 2 |
| Illinois | $277.87 | $98.11 | $263.68 - $290.09 | 4 |
| Michigan | $268.12 | $93.43 | $260.49 - $275.75 | 2 |
| North Carolina | $261.19 | $87.61 | $261.19 - $261.19 | 1 |
| New York | $308.36 | $100.81 | $265.31 - $328.71 | 5 |
| Ohio | $259.6 | $89.75 | $259.6 - $259.6 | 1 |
| Pennsylvania | $274.84 | $92.61 | $260.21 - $289.46 | 2 |
| Texas | $274.69 | $91.53 | $258.38 - $289.96 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 43201
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43201 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00520 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00731 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00732 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00740 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00810 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00811 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00812 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00813 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 43201
What does CPT code 43201 mean? +
CPT code 43201 represents: Esoph scope w/submucous inj. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 43201? +
The 2026 Medicare national average non-facility payment for CPT 43201 is $287.69. Rates range from $244.38 to $375.92 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43201? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 43201? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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