CPT code 43216: Esophageal lesion removal, hot forceps or bipolar cautery2026 Medicare rate & RVUs in California
Flexible esophagoscopy removes an esophageal tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery during the procedure.
Medicare pays $487.83–$623.41 for 43216 in the office in California, from Chico, CA to San Benito County, CA. 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.
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On this page 9 sections
What 43216 covers
A gastroenterologist or other qualified endoscopist advances a flexible scope through the mouth to inspect the esophagus and remove a lesion with hot biopsy forceps or bipolar cautery. The service is used for therapeutic removal of an esophageal tumor, polyp, or other lesion, rather than inspection or tissue sampling alone. It is commonly performed in a facility-based endoscopy setting.
Report this code when the documented removal technique is hot biopsy forceps or bipolar cautery. The procedure note should identify the esophageal lesion and describe its removal and the technique used. 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. CMS does not pay an assistant at surgery; 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 43216 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$487.83 to $623.41
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $488.56 | $121.02 |
| Chico, CA | $487.83 | $120.29 |
| El Centro, CA | $487.87 | $120.33 |
| Fresno, CA | $487.83 | $120.29 |
| Hanford, CA | $487.83 | $120.29 |
| Los Angeles, CA | $522.99 | $126.28 |
| Madera, CA | $487.83 | $120.29 |
| Marin County, CA | $609.78 | $136.94 |
| Merced, CA | $487.83 | $120.29 |
| Modesto, CA | $487.83 | $120.29 |
| Napa, CA | $573.57 | $131.59 |
| Oxnard, CA | $521.32 | $124.94 |
| Redding, CA | $487.83 | $120.29 |
| Rest of California | $487.83 | $120.29 |
| Riverside, CA | $490.44 | $122.90 |
| Sacramento, CA | $514.16 | $124.15 |
| Salinas, CA | $512.29 | $123.63 |
| San Benito County, CA | $623.41 | $139.84 |
| San Diego, CA | $526.02 | $124.95 |
| San Francisco, CA | $609.50 | $136.67 |
| San Luis Obispo, CA | $503.81 | $121.85 |
| Santa Clara County, CA | $622.30 | $138.73 |
| Santa Cruz, CA | $532.36 | $124.92 |
| Santa Maria, CA | $514.67 | $123.66 |
| Santa Rosa, CA | $537.87 | $126.07 |
| Stockton, CA | $487.83 | $120.29 |
| Vallejo, CA | $573.18 | $131.20 |
| Visalia, CA | $487.83 | $120.29 |
| Yuba City, CA | $487.83 | $120.29 |
How the 43216 rate is calculated
Each of 43216’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 · 43216
RVUs × geographic indexes × conversion factor
Work2.24
2.24 RVUs× 1.000 GPCI
Practice expense11.13
11.13 RVUs× 1.000 GPCI
Malpractice0.24
0.24 RVUs× 1.000 GPCI
Adjusted RVUs
13.6100
Conversion factor
$33.4009
Medicare rate
$454.59
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43216
The CMS indicators that decide how 43216 is paid alongside other services.
CMS payment indicators · 43216
Esophageal lesion removal, hot forceps or bipolar cautery
| 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
43216 without 51 · national office
$454.59
Esophageal lesion removal, hot forceps or bipolar cautery
43216-51 · Second procedure: 50%
$227.30
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%).
43216 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43217Esophageal lesion removalSnare technique
- 43216 uses hot biopsy forceps or bipolar cautery to remove the lesion; 43217 is the snare-removal service.
- 43211Esophageal resectionEndoscopic mucosal resection
- 43211 is for endoscopic mucosal resection of an esophageal lesion. This code is selected for removal with hot biopsy forceps or bipolar cautery.
- 43229Esophageal ablationFlexible transoral scope
- 43229 is used for lesion ablation. This code describes lesion removal using hot biopsy forceps or bipolar cautery.
- 43202Esophageal biopsyFlexible transoral scope
- 43202 is for biopsy during flexible esophagoscopy; this code is for therapeutic removal of an esophageal lesion.
43216 billing questions
How does this differ from 43217?
This code is for lesion removal with hot biopsy forceps or bipolar cautery. Use 43217 when a snare is used to remove the lesion.
When is 43211 a better choice?
43211 describes esophageal mucosal resection. Choose it when the documented therapeutic method is mucosal resection rather than removal with hot biopsy forceps or bipolar cautery.
Can a diagnostic biopsy be reported instead?
Use 43202 when the service is flexible esophagoscopy with biopsy rather than therapeutic lesion removal. The procedure documentation should support the service actually performed.
How does CMS price related endoscopies performed together?
CMS applies endoscopy-family pricing when related endoscopies are performed together. Payment is subject to that family pricing rather than treating every related endoscopy as an unrelated standalone service.
Which surgical modifiers or providers are permitted?
Modifier 50 is inappropriate. CMS does not pay an assistant at surgery for this service, and 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 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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