CPT 43236
Global 000 ActiveUppr gi scope w/submuc inj
CPT 43236 Billing & Documentation Guide
CPT code 43236 (Uppr gi scope w/submuc inj) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.33, a non-facility practice expense RVU of 10.76, and a malpractice RVU of 0.27, a total non-facility RVU of 13.36 and facility RVU of 3.7. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $462.21, though rates vary from $391.19 to $609.46 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43236, 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 43236 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 43236 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 43236
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.33 | 2.33 |
| Practice Expense RVU | 10.76 | 1.1 |
| Malpractice RVU | 0.27 | 0.27 |
| Total RVU | 13.36 | 3.7 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43236
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 | $510.77 | $128.98 | $477.88 - $609.46 | 29 |
| Florida | $455.97 | $132.24 | $434.96 - $474.76 | 3 |
| Georgia | $431.59 | $123.79 | $409.15 - $454.03 | 2 |
| Illinois | $442.6 | $130.83 | $420.05 - $463.45 | 4 |
| Michigan | $427.99 | $125.01 | $416.13 - $439.84 | 2 |
| North Carolina | $418.9 | $117.87 | $418.9 - $418.9 | 1 |
| New York | $494.71 | $134.76 | $425.59 - $526.87 | 5 |
| Ohio | $415.04 | $120.46 | $415.04 - $415.04 | 1 |
| Pennsylvania | $440.19 | $124.15 | $416.27 - $464.11 | 2 |
| Texas | $440.45 | $122.8 | $413.25 - $466.21 | 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 43236
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43236 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 43236
What does CPT code 43236 mean? +
CPT code 43236 represents: Uppr gi scope w/submuc inj. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 43236? +
The 2026 Medicare national average non-facility payment for CPT 43236 is $462.21. Rates range from $391.19 to $609.46 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43236? +
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 43236? +
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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