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CPT code 43216: Esophageal lesion removal, hot forceps or bipolar cautery2026 Medicare rate & RVUs in Chicago, IL

Flexible esophagoscopy removes an esophageal tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery during the procedure.

CMS RVU26DEffective Oct 1, 2026One payment locality255 Medicare services in 2024

In Chicago, IL, Medicare pays $467.35 for 43216 in the office and $130.33 when it’s performed in a hospital or facility.

$467.35Office (non-facility)
$130.33Hospital or facility
+2.8%vs the national office rate ($454.59)

Check a contract rate as a % of Medicare · 43216 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 43216 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Chicago, IL
  2. What 43216 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Chicago, IL compares for 43216

Across 109 of 109 payment localities, the office rate for 43216 runs from $398.28 in Arkansas to $623.41 in San Benito County, CA. Chicago, IL pays $467.35. The RVUs are the same everywhere; the geographic indexes change the dollars.

43216 in Chicago, IL vs other payment areas
  1. Chicago, IL · this page$467.35
  2. East St. Louis, IL · Illinois$432.97−$34.38
  3. Rest of Illinois · Illinois$426.76−$40.59
  4. Suburban Chicago, IL · Illinois$471.34+$3.99
  5. Los Angeles, CA · California$522.99+$55.64
  6. Washington, DC area · District of Columbia$525.70+$58.35
  7. Miami, FL · Florida$482.08+$14.73

Other areas in Illinois first, then benchmark localities. Bars start at $0.

Every other payment area

43216 in every other Medicare payment locality
Payment localityOfficeFacility
Manhattan, NYNew York$524.30$134.62
AlaskaAlaska$512.56$155.42
AlabamaAlabama$404.64$111.21
ArkansasArkansas$398.28$110.22
ArizonaArizona$441.91$116.96
Bakersfield, CACalifornia$488.56$121.02
Chico, CACalifornia$487.83$120.29
El Centro, CACalifornia$487.87$120.33

43216 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$398.28

$555.62

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
43216 office rate range by state
State / territoryOffice rate rangeLocalities
AK$512.561
AL$404.641
AR$398.281
AZ$441.911
CA$487.83–$623.4129
CO$477.521
CT$486.391
DC$525.701
DE$449.691
FL$442.26–$482.083
GA$415.98–$462.372
GU$502.141
HI$502.141
IA$418.151
ID$420.621
IL$426.76–$471.344
IN$423.331
KS$414.921
KY$412.641
LA$411.50–$433.742
MA$473.86–$528.892
MD$459.14–$525.703
ME$421.82–$448.282
MI$423.28–$447.072
MN$459.721
MO$403.08–$436.763
MS$400.821
MT$454.571
NC$426.791
ND$449.821
NE$420.981
NH$468.831
NJ$492.56–$519.332
NM$425.341
NV$453.621
NY$433.62–$536.515
OH$422.311
OK$413.021
OR$450.72–$495.002
PA$423.66–$472.722
PR$458.561
RI$467.411
SC$425.131
SD$449.261
TN$417.051
TX$420.56–$475.388
UT$431.461
VA$445.91–$525.702
VI$458.561
VT$446.911
WA$473.35–$541.252
WI$433.431
WV$409.341
WY$452.501

See 43216 in every payment locality

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

Office or facility?

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.

The exact Chicago, IL inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,153

Code
43216
Physician work
2.24
Practice expense
11.13
Malpractice
0.24

GPCI2026.csv

48

Locality
Chicago, IL
Physician work
1.007
Practice expense
1.005
Malpractice
2.295
Office calculation for 43216 in Chicago, IL
ComponentRVULocality factorAdjusted
Physician work2.24× 1.0072.2557
Practice expense11.13× 1.00511.1856
Malpractice0.24× 2.2950.5508
Total RVUs13.9921
Conversion factor× 33.4009

Office rate, Chicago, IL$467.35

Office: (2.24 × 1.007 + 11.13 × 1.005 + 0.24 × 2.295) × $33.4009 = $467.35

Facility: (2.24 × 1.007 + 1.09 × 1.005 + 0.24 × 2.295) × $33.4009 = $130.33

Open 43216 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 43216

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 43216
CodeHow it relatesOffice range, Chicago, IL
Used instead
43217Esophageal lesion removal, snare techniqueUsed instead when an esophageal lesion is removed with a snare.$483.39
43211Esophageal resection, endoscopic mucosal resectionUsed for esophageal mucosal resection rather than forceps or bipolar-cautery removal.No office rate
43229Esophageal ablation, flexible transoral scopeUsed when the esophageal lesion is ablated rather than removed with this technique.$803.72
43202Esophageal biopsy, flexible transoral scopeUsed for esophageal biopsy sampling without therapeutic lesion removal.$404.25

How 43216 has changed in Chicago, IL

43216 · Office / nonfacility

$467.35

Effective 2026-10-01

The base rate is $64.43 higher than on 2025-10-01, moving from $402.92 to $467.35 (16.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $402.92changed to$467.35

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.30 changed to 2.24
    • Practice expense RVU 9.36 changed to 11.13
    • Malpractice RVU 0.28 changed to 0.24
    • Practice expense GPCI 1.023 changed to 1.005
    • Malpractice GPCI 2.018 changed to 2.295

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $423.85changed to$402.92

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 9.65 changed to 9.36
    • Malpractice RVU 0.27 changed to 0.28

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $416.93changed to$423.85

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $438.79changed to$416.93

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.78 changed to 9.65
    • Work GPCI 1.009 changed to 1.007
    • Practice expense GPCI 1.033 changed to 1.023
    • Malpractice GPCI 1.945 changed to 2.018

  5. January 1, 2023

    RVU23A

    $463.36changed to$438.79

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.15 changed to 9.78
    • Malpractice RVU 0.25 changed to 0.27
    • Work GPCI 1.011 changed to 1.009
    • Practice expense GPCI 1.044 changed to 1.033
    • Malpractice GPCI 1.871 changed to 1.945

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $462.76changed to$463.36

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.01 changed to 10.15
    • Malpractice RVU 0.26 changed to 0.25

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $425.47changed to$462.76

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.62 changed to 10.01
    • Malpractice RVU 0.27 changed to 0.26
    • Work GPCI 1.009 changed to 1.011
    • Practice expense GPCI 1.039 changed to 1.044
    • Malpractice GPCI 1.898 changed to 1.871

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $402.64changed to$425.47

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.06 changed to 8.62
    • Work GPCI 1.008 changed to 1.009
    • Practice expense GPCI 1.034 changed to 1.039
    • Malpractice GPCI 1.925 changed to 1.898

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $386.83changed to$402.64

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.61 changed to 8.06
    • Malpractice RVU 0.29 changed to 0.27

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $384.37changed to$386.83

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.52 changed to 7.61
    • Malpractice RVU 0.30 changed to 0.29
    • Work GPCI 1.012 changed to 1.008
    • Practice expense GPCI 1.036 changed to 1.034
    • Malpractice GPCI 1.972 changed to 1.925

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $445.73changed to$384.37

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.40 changed to 2.30
    • Practice expense RVU 9.05 changed to 7.52
    • Malpractice RVU 0.31 changed to 0.30
    • Work GPCI 1.016 changed to 1.012
    • Practice expense GPCI 1.037 changed to 1.036
    • Malpractice GPCI 2.019 changed to 1.972

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $459.19changed to$445.73

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.29 changed to 9.05
    • Malpractice RVU 0.35 changed to 0.31

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $456.90changed to$459.19

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $455.49changed to$456.90

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.18 changed to 9.29
    • Malpractice RVU 0.33 changed to 0.35
    • Work GPCI 1.023 changed to 1.016
    • Practice expense GPCI 1.044 changed to 1.037
    • Malpractice GPCI 2.048 changed to 2.019

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $254.02changed to$455.49

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.06 changed to 9.18
    • Malpractice RVU 0.35 changed to 0.33
    • Work GPCI 1.030 changed to 1.023
    • Practice expense GPCI 1.051 changed to 1.044
    • Malpractice GPCI 2.077 changed to 2.048

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$254.02

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$467.35$130.33RVU26D
2026-07-01$467.35$130.33RVU26C
2026-04-01$467.35$130.33RVU26B
2026-01-01$467.35$130.33RVU26A
2025-10-01$402.92$139.52RVU25D
2025-07-01$402.92$139.52RVU25C
2025-04-01$402.92$139.52RVU25B
2025-01-01$402.92$139.52RVU25A
2024-10-01$423.85$142.23RVU24D
2024-07-01$423.85$142.23RVU24C
2024-04-01$423.85$142.23RVU24B
2024-03-09$423.85$142.23RVU24AR
2024-01-01$416.93$139.91RVU24A
2023-10-01$438.79$143.35RVU23D
2023-07-01$438.79$143.35RVU23C
2023-04-01$438.79$143.35RVU23B
2023-01-01$438.79$143.35RVU23A
2022-10-01$463.36$145.43RVU22D
2022-07-01$463.36$145.43RVU22C
2022-04-01$463.36$145.43RVU22B
2022-01-01$463.36$145.43RVU22A
2021-10-01$462.76$146.56RVU21D
2021-07-01$462.76$146.56RVU21C
2021-04-01$462.76$146.56RVU21B
2021-01-01$462.76$146.56RVU21A
2020-10-01$425.47$150.62RVU20D
2020-07-01$425.47$150.62RVU20C
2020-04-01$425.47$150.62RVU20B
2020-01-01$425.47$150.62RVU20A
2019-10-01$402.64$150.36RVU19D
2019-07-01$402.64$150.36RVU19C
2019-04-01$402.64$150.36RVU19B
2019-01-01$402.64$150.36RVU19A
2018-10-01$386.83$152.69RVU18D
2018-07-01$386.83$152.69RVU18C
2018-04-01$386.83$152.69RVU18B
2018-01-01$386.83$152.69RVU18AR1
2017-10-01$384.37$154.96RVU17D
2017-07-01$384.37$154.96RVU17C
2017-04-01$384.37$154.96RVU17B
2017-01-01$384.37$154.96RVU17A
2016-10-01$445.73$160.58RVU16D
2016-07-01$445.73$160.58RVU16C
2016-04-01$445.73$160.58RVU16B
2016-01-01$445.73$160.58RVU16A
2015-10-01$459.19$166.30RVU15D
2015-07-01$459.19$166.30RVU15C
2015-04-01$456.90$165.47RVU15B
2015-01-01$456.90$165.47RVU15A
2014-10-01$455.49$166.02RVU14D
2014-07-01$455.49$166.02RVU14C
2014-04-01$455.49$166.02RVU14B
2014-01-01$455.49$166.02RVU14A
2013-10-01$254.02$169.63RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 43216 for an earlier date of service

Where the Chicago, IL rate applies

Chicago, IL is a Medicare payment area, not a city. Our Census mapping connects it to 137 cities and communities in Illinois. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Illinois

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
RVUs for 43216PPRRVU2026_Oct_nonQPP.csv, line 5,153 (RVU26D)
Geographic factors for Chicago, ILGPCI2026.csv, line 48 (RVU26D)

Open CMS sourceHow we calculate rates

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