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CPT code 43250: Upper endoscopy, cautery lesion removal2026 Medicare rate & RVUs in Puerto Rico

Reports upper endoscopic removal of a tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery.

CMS RVU26DEffective Oct 1, 2026One payment locality3.5K Medicare services in 2024

In Puerto Rico, Medicare pays $502.73 for 43250 in the office and $152.89 when it’s performed in a hospital or facility.

$502.73Office (non-facility)
$152.89Hospital or facility
+0.8%vs the national office rate ($498.68)

Check a contract rate as a % of Medicare · 43250 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 43250 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 43250 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 43250 covers

During a transoral upper endoscopy, the physician examines the esophagus, stomach, and duodenum and removes a lesion using hot biopsy forceps or bipolar cautery. Gastroenterologists commonly perform this therapeutic procedure in an endoscopy unit or hospital, and it may also be performed in an appropriately equipped office. The defining feature is removal by the specified cautery technique, rather than snare excision or mucosal resection.

Select the code based on the documented removal method, not simply the presence of a lesion. The report should identify the treated site and lesion and describe 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 anatomy and descriptor. Medicare does not pay for 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.

How Puerto Rico compares for 43250

Across 109 of 109 payment localities, the office rate for 43250 runs from $437.19 in Arkansas to $674.22 in San Benito County, CA. Puerto Rico pays $502.73. The RVUs are the same everywhere; the geographic indexes change the dollars.

43250 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$502.73
  2. Los Angeles, CA · California$568.90+$66.17
  3. Washington, DC area · District of Columbia$574.52+$71.79
  4. Miami, FL · Florida$536.02+$33.29
  5. Chicago, IL · Illinois$519.46+$16.73
  6. Manhattan, NY · New York$575.92+$73.19
  7. Alaska · Alaska$566.01+$63.28

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

Every other payment area

43250 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$444.11$141.33
ArkansasArkansas$437.19$139.95
ArizonaArizona$484.63$149.33
Bakersfield, CACalifornia$532.26$153.01
Chico, CACalifornia$531.04$151.79
El Centro, CACalifornia$531.11$151.86
Fresno, CACalifornia$531.04$151.79
Hanford, CACalifornia$531.04$151.79

43250 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.

$437.19

$602.63

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

View every state and territory as a table
43250 office rate range by state
State / territoryOffice rate rangeLocalities
AK$566.011
AL$444.111
AR$437.191
AZ$484.631
CA$531.04–$674.2229
CO$521.581
CT$533.421
DC$574.521
DE$493.091
FL$488.67–$536.023
GA$459.49–$507.992
GU$545.901
HI$545.901
IA$457.251
ID$460.261
IL$472.84–$520.654
IN$463.161
KS$454.491
KY$454.441
LA$453.49–$477.702
MA$517.93–$576.332
MD$503.15–$574.523
ME$462.35–$490.012
MI$466.75–$494.732
MN$500.051
MO$444.80–$480.093
MS$441.111
MT$498.651
NC$467.631
ND$490.341
NE$460.091
NH$512.821
NJ$539.59–$567.782
NM$469.311
NV$496.721
NY$475.12–$590.195
OH$465.051
OK$454.051
OR$492.96–$539.682
PA$466.11–$519.032
PR$502.731
RI$511.801
SC$467.101
SD$489.361
TN$456.891
TX$462.78–$519.768
UT$473.981
VA$487.96–$574.522
VI$502.731
VT$487.871
WA$517.13–$588.982
WI$472.681
WV$453.921
WY$495.031

See 43250 in every payment locality

How the 43250 rate is calculated

Each of 43250’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 · 43250

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.90

2.90 RVUs× 1.000 GPCI

Practice expense11.61

11.61 RVUs× 1.000 GPCI

Malpractice0.42

0.42 RVUs× 1.000 GPCI

Adjusted RVUs

14.9300

Conversion factor

$33.4009

Medicare rate

$498.68

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,179

Code
43250
Physician work
2.90
Practice expense
11.61
Malpractice
0.42

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 43250 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.90× 1.0002.9000
Practice expense11.61× 1.01111.7377
Malpractice0.42× 0.9850.4137
Total RVUs15.0514
Conversion factor× 33.4009

Office rate, Puerto Rico$502.73

Office: (2.9 × 1 + 11.61 × 1.011 + 0.42 × 0.985) × $33.4009 = $502.73

Facility: (2.9 × 1 + 1.25 × 1.011 + 0.42 × 0.985) × $33.4009 = $152.89

Open 43250 in the RVU calculator

Payment rules and modifiers for 43250

The CMS indicators that decide how 43250 is paid alongside other services.

CMS payment indicators · 43250

Upper endoscopy, cautery lesion removal

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

43250 without 51 · national office

$498.68

Upper endoscopy, cautery lesion removal

43250-51 · Second procedure: 50%

$249.34

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 43250

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

Codes related to 43250
CodeHow it relatesOffice range, Puerto Rico
Same family
43251EGD lesion removal, snare techniqueUpper endoscopic lesion removal by snare rather than cautery.$550.19
Used instead
43254Endoscopic resection, mucosal resectionUpper endoscopic lesion treatment by mucosal resection.No office rate
43239EGD with biopsy, single or multiple biopsiesUpper endoscopic tissue sampling when biopsy, rather than cautery removal, is performed.$422.36

How 43250 has changed in Puerto Rico

43250 · Office / nonfacility

$502.73

Effective 2026-10-01

The base rate is $73.80 higher than on 2025-10-01, moving from $428.93 to $502.73 (17.2%).

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

    $428.93changed to$502.73

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.97 changed to 2.90
    • Practice expense RVU 9.79 changed to 11.61
    • Malpractice RVU 0.44 changed to 0.42
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $449.80changed to$428.93

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.05 changed to 9.79
    • Malpractice RVU 0.43 changed to 0.44

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $442.46changed to$449.80

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $463.06changed to$442.46

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.19 changed to 10.05
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $460.53changed to$463.06

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $486.17changed to$460.53

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.58 changed to 10.19
    • Malpractice RVU 0.42 changed to 0.43
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $485.62changed to$486.17

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.44 changed to 10.58
    • Malpractice RVU 0.43 changed to 0.42

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $448.10changed to$485.62

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.94 changed to 10.44
    • Malpractice RVU 0.44 changed to 0.43
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $427.21changed to$448.10

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.37 changed to 8.94
    • Malpractice RVU 0.46 changed to 0.44
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $410.42changed to$427.21

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.91 changed to 8.37
    • Malpractice RVU 0.47 changed to 0.46

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $358.35changed to$410.42

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.85 changed to 7.91
    • Malpractice RVU 0.46 changed to 0.47
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $352.12changed to$358.35

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.07 changed to 2.97
    • Practice expense RVU 9.40 changed to 7.85
    • Malpractice RVU 0.47 changed to 0.46
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $357.76changed to$352.12

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.56 changed to 9.40
    • Malpractice RVU 0.50 changed to 0.47

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $355.98changed to$357.76

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $348.90changed to$355.98

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.45 changed to 9.56
    • Malpractice RVU 0.48 changed to 0.50
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    No ratechanged to$348.90

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$502.73$152.89RVU26D
2026-07-01$502.73$152.89RVU26C
2026-04-01$502.73$152.89RVU26B
2026-01-01$502.73$152.89RVU26A
2025-10-01$428.93$163.79RVU25D
2025-07-01$428.93$163.79RVU25C
2025-04-01$428.93$163.79RVU25B
2025-01-01$428.93$163.79RVU25A
2024-10-01$449.80$167.56RVU24D
2024-07-01$449.80$167.56RVU24C
2024-04-01$449.80$167.56RVU24B
2024-03-09$449.80$167.56RVU24AR
2024-01-01$442.46$164.82RVU24A
2023-10-01$463.06$169.64RVU23D
2023-07-01$460.53$169.44RVU23C
2023-04-01$460.53$169.44RVU23B
2023-01-01$460.53$169.44RVU23A
2022-10-01$486.17$172.58RVU22D
2022-07-01$486.17$172.58RVU22C
2022-04-01$486.17$172.58RVU22B
2022-01-01$486.17$172.58RVU22A
2021-10-01$485.62$174.00RVU21D
2021-07-01$485.62$174.00RVU21C
2021-04-01$485.62$174.00RVU21B
2021-01-01$485.62$174.00RVU21A
2020-10-01$448.10$178.53RVU20D
2020-07-01$448.10$178.53RVU20C
2020-04-01$448.10$178.53RVU20B
2020-01-01$448.10$178.53RVU20A
2019-10-01$427.21$179.34RVU19D
2019-07-01$427.21$179.34RVU19C
2019-04-01$427.21$179.34RVU19B
2019-01-01$427.21$179.34RVU19A
2018-10-01$410.42$180.58RVU18D
2018-07-01$410.42$180.58RVU18C
2018-04-01$410.42$180.58RVU18B
2018-01-01$410.42$180.58RVU18AR1
2017-10-01$358.35$165.42RVU17D
2017-07-01$358.35$165.42RVU17C
2017-04-01$358.35$165.42RVU17B
2017-01-01$358.35$165.42RVU17A
2016-10-01$352.12$155.49RVU16D
2016-07-01$352.12$155.49RVU16C
2016-04-01$352.12$155.49RVU16B
2016-01-01$352.12$155.49RVU16A
2015-10-01$357.76$157.38RVU15D
2015-07-01$357.76$157.38RVU15C
2015-04-01$355.98$156.60RVU15B
2015-01-01$355.98$156.60RVU15A
2014-10-01$348.90$155.79RVU14D
2014-07-01$348.90$155.79RVU14C
2014-04-01$348.90$155.79RVU14B
2014-01-01$348.90$155.79RVU14A
2013-10-01Not available in this setting$157.80RVU13D
2013-07-01Not available in this setting$157.80RVU13C
2013-04-01Not available in this setting$157.80RVU13B
2013-01-01Not available in this setting$157.80RVU13AR

Price 43250 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

43250 billing questions

How does this differ from 43251?

This code is for lesion removal with hot biopsy forceps or bipolar cautery. Code 43251 describes removal by snare, so the documented technique distinguishes them.

When is 43254 a better choice?

Use 43254 when the physician performs endoscopic mucosal resection. This code instead identifies removal using hot biopsy forceps or bipolar cautery.

Should units be based on the number of lesions?

Document each treated lesion and the technique, but do not assume that each lesion supports a separate unit. The service is an upper endoscopic removal procedure.

What documentation supports this code?

The procedure report should identify the lesion and its location and state that removal was performed with hot biopsy forceps or bipolar cautery.

Can a modifier 50 be used for lesions on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this descriptor and anatomy.

How are related endoscopies handled when performed together?

CMS endoscopy family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included in this code's 0-day global period.

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 43250PPRRVU2026_Oct_nonQPP.csv, line 5,179 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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