CPT code 43250: Upper endoscopy, cautery lesion removal2026 Medicare rate & RVUs in South Dakota
Reports upper endoscopic removal of a tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery.
In South Dakota, Medicare pays $489.36 for 43250 in the office and $143.33 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 South Dakota 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. South Dakota pays $489.36. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$489.36
- Los Angeles, CA · California$568.90+$79.54
- Washington, DC area · District of Columbia$574.52+$85.16
- Miami, FL · Florida$536.02+$46.66
- Chicago, IL · Illinois$519.46+$30.10
- Manhattan, NY · New York$575.92+$86.56
- Alaska · Alaska$566.01+$76.65
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $531.04 | $151.79 |
| Merced, CACalifornia | $531.04 | $151.79 |
| Modesto, CACalifornia | $531.04 | $151.79 |
| Napa, CACalifornia | $621.19 | $165.12 |
| Oxnard, CACalifornia | $566.68 | $157.66 |
| Redding, CACalifornia | $531.04 | $151.79 |
| Rest of CaliforniaCalifornia | $531.04 | $151.79 |
| Riverside, CACalifornia | $535.58 | $156.33 |
| Sacramento, CACalifornia | $558.86 | $156.43 |
| Salinas, CACalifornia | $556.83 | $155.77 |
| San Diego, CACalifornia | $571.16 | $157.31 |
| Marin County, CACalifornia | $659.28 | $171.37 |
| San Francisco, CACalifornia | $658.80 | $170.90 |
| San Benito County, CACalifornia | $674.22 | $175.24 |
| Santa Clara County, CACalifornia | $672.27 | $173.29 |
| San Luis Obispo, CACalifornia | $547.71 | $153.58 |
| Santa Cruz, CACalifornia | $577.57 | $157.14 |
| Santa Maria, CACalifornia | $559.25 | $155.78 |
| Santa Rosa, CACalifornia | $583.49 | $158.56 |
| Stockton, CACalifornia | $531.04 | $151.79 |
| Vallejo, CACalifornia | $620.50 | $164.43 |
| Visalia, CACalifornia | $531.04 | $151.79 |
| Yuba City, CACalifornia | $531.04 | $151.79 |
| ColoradoColorado | $521.58 | $153.40 |
| ConnecticutConnecticut | $533.42 | $160.74 |
| DelawareDelaware | $493.09 | $151.21 |
| Fort Lauderdale, FLFlorida | $515.05 | $164.52 |
| Rest of FloridaFlorida | $488.67 | $157.86 |
| Atlanta, GAGeorgia | $507.99 | $156.42 |
| Rest of GeorgiaGeorgia | $459.49 | $150.83 |
| Hawaii, Guam, HIHawaii | $545.90 | $152.46 |
| IowaIowa | $457.25 | $140.63 |
| IdahoIdaho | $460.26 | $141.91 |
| East St. Louis, ILIllinois | $481.88 | $163.53 |
| Rest of IllinoisIllinois | $472.84 | $156.91 |
| Suburban Chicago, ILIllinois | $520.65 | $165.28 |
| IndianaIndiana | $463.16 | $142.38 |
| KansasKansas | $454.49 | $141.68 |
| KentuckyKentucky | $454.44 | $146.82 |
| New Orleans, LALouisiana | $477.70 | $152.09 |
| Rest of LouisianaLouisiana | $453.49 | $147.25 |
| Metropolitan Boston, MAMassachusetts | $576.33 | $163.17 |
| Rest of MassachusettsMassachusetts | $517.93 | $153.56 |
| Baltimore area, MDMaryland | $531.86 | $160.56 |
| Rest of MarylandMaryland | $503.15 | $152.96 |
| Rest of MaineMaine | $462.35 | $144.00 |
| Southern Maine, MEMaine | $490.01 | $147.09 |
| Detroit, MIMichigan | $494.73 | $160.80 |
| Rest of MichiganMichigan | $466.75 | $150.82 |
| MinnesotaMinnesota | $500.05 | $143.98 |
| Metropolitan Kansas City, MOMissouri | $474.70 | $149.77 |
| Metropolitan St. Louis, MOMissouri | $480.09 | $150.67 |
| Rest of MissouriMissouri | $444.80 | $146.52 |
| MississippiMississippi | $441.11 | $143.18 |
| MontanaMontana | $498.65 | $152.61 |
| North CarolinaNorth Carolina | $467.63 | $144.78 |
| North DakotaNorth Dakota | $490.34 | $144.31 |
| NebraskaNebraska | $460.09 | $140.70 |
| New HampshireNew Hampshire | $512.82 | $152.60 |
| Northern New JerseyNew Jersey | $567.78 | $166.38 |
| Rest of New JerseyNew Jersey | $539.59 | $161.72 |
| New MexicoNew Mexico | $469.31 | $152.00 |
| NevadaNevada | $496.72 | $150.34 |
| NYC suburbs and Long Island, NYNew York | $590.19 | $178.75 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $542.82 | $163.91 |
| Queens, NYNew York | $581.65 | $172.64 |
| Rest of New YorkNew York | $475.12 | $146.39 |
| OhioOhio | $465.05 | $149.12 |
| OklahomaOklahoma | $454.05 | $145.05 |
| Portland, OROregon | $539.68 | $155.24 |
| Rest of OregonOregon | $492.96 | $148.31 |
| Metropolitan Philadelphia, PAPennsylvania | $519.03 | $158.80 |
| Rest of PennsylvaniaPennsylvania | $466.11 | $148.45 |
| Puerto RicoPuerto Rico | $502.73 | $152.89 |
| Rhode IslandRhode Island | $511.80 | $154.35 |
| South CarolinaSouth Carolina | $467.10 | $147.36 |
| TennesseeTennessee | $456.89 | $142.35 |
| Austin, TXTexas | $519.76 | $153.66 |
| Beaumont, TXTexas | $462.78 | $147.89 |
| Brazoria, TXTexas | $492.87 | $149.96 |
| Dallas, TXTexas | $496.00 | $151.35 |
| Fort Worth, TXTexas | $492.31 | $151.12 |
| Galveston, TXTexas | $494.32 | $150.71 |
| Houston, TXTexas | $502.01 | $158.40 |
| Rest of TexasTexas | $477.54 | $149.15 |
| UtahUtah | $473.98 | $148.71 |
| VirginiaVirginia | $487.96 | $147.81 |
| Virgin Islands, VIUnited States Virgin Islands | $502.73 | $152.89 |
| VermontVermont | $487.87 | $145.29 |
| Rest of WashingtonWashington | $517.13 | $152.76 |
| King County, WAWashington | $588.98 | $164.40 |
| WisconsinWisconsin | $472.68 | $141.18 |
| West VirginiaWest Virginia | $453.92 | $153.22 |
| WyomingWyoming | $495.03 | $148.99 |
43250 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $566.01 | 1 |
| AL | $444.11 | 1 |
| AR | $437.19 | 1 |
| AZ | $484.63 | 1 |
| CA | $531.04–$674.22 | 29 |
| CO | $521.58 | 1 |
| CT | $533.42 | 1 |
| DC | $574.52 | 1 |
| DE | $493.09 | 1 |
| FL | $488.67–$536.02 | 3 |
| GA | $459.49–$507.99 | 2 |
| GU | $545.90 | 1 |
| HI | $545.90 | 1 |
| IA | $457.25 | 1 |
| ID | $460.26 | 1 |
| IL | $472.84–$520.65 | 4 |
| IN | $463.16 | 1 |
| KS | $454.49 | 1 |
| KY | $454.44 | 1 |
| LA | $453.49–$477.70 | 2 |
| MA | $517.93–$576.33 | 2 |
| MD | $503.15–$574.52 | 3 |
| ME | $462.35–$490.01 | 2 |
| MI | $466.75–$494.73 | 2 |
| MN | $500.05 | 1 |
| MO | $444.80–$480.09 | 3 |
| MS | $441.11 | 1 |
| MT | $498.65 | 1 |
| NC | $467.63 | 1 |
| ND | $490.34 | 1 |
| NE | $460.09 | 1 |
| NH | $512.82 | 1 |
| NJ | $539.59–$567.78 | 2 |
| NM | $469.31 | 1 |
| NV | $496.72 | 1 |
| NY | $475.12–$590.19 | 5 |
| OH | $465.05 | 1 |
| OK | $454.05 | 1 |
| OR | $492.96–$539.68 | 2 |
| PA | $466.11–$519.03 | 2 |
| PR | $502.73 | 1 |
| RI | $511.80 | 1 |
| SC | $467.10 | 1 |
| SD | $489.36 | 1 |
| TN | $456.89 | 1 |
| TX | $462.78–$519.76 | 8 |
| UT | $473.98 | 1 |
| VA | $487.96–$574.52 | 2 |
| VI | $502.73 | 1 |
| VT | $487.87 | 1 |
| WA | $517.13–$588.98 | 2 |
| WI | $472.68 | 1 |
| WV | $453.92 | 1 |
| WY | $495.03 | 1 |
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
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 South Dakota 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
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.90 | × 1.000 | 2.9000 |
| Practice expense | 11.61 | × 1.000 | 11.6100 |
| Malpractice | 0.42 | × 0.336 | 0.1411 |
| Total RVUs | 14.6511 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$489.36
Office: (2.9 × 1 + 11.61 × 1 + 0.42 × 0.336) × $33.4009 = $489.36
Facility: (2.9 × 1 + 1.25 × 1 + 0.42 × 0.336) × $33.4009 = $143.33
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
| 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
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%).
How 43250 has changed in South Dakota
43250 · Office / nonfacility
$489.36
Effective 2026-10-01
The base rate is $71.18 higher than on 2025-10-01, moving from $418.18 to $489.36 (17.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$418.18changed to$489.36
- 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
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$438.87changed to$418.18
- 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.
March 9, 2024
RVU24AR
$431.71changed to$438.87
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$451.26changed to$431.71
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 10.19 changed to 10.05
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$473.96changed to$451.26
- 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
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$473.12changed to$473.96
- 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.
January 1, 2021
RVU21A
$435.67changed to$473.12
- 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 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$415.13changed to$435.67
- 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
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$398.26changed to$415.13
- 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.
January 1, 2018
RVU18AR1
$394.84changed to$398.26
- 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
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$453.21changed to$394.84
- 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
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$461.03changed to$453.21
- 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.
July 1, 2015
RVU15C
$458.73changed to$461.03
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$455.65changed to$458.73
- 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
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$455.65
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $489.36 | $143.33 | RVU26D |
| 2026-07-01 | $489.36 | $143.33 | RVU26C |
| 2026-04-01 | $489.36 | $143.33 | RVU26B |
| 2026-01-01 | $489.36 | $143.33 | RVU26A |
| 2025-10-01 | $418.18 | $154.88 | RVU25D |
| 2025-07-01 | $418.18 | $154.88 | RVU25C |
| 2025-04-01 | $418.18 | $154.88 | RVU25B |
| 2025-01-01 | $418.18 | $154.88 | RVU25A |
| 2024-10-01 | $438.87 | $158.59 | RVU24D |
| 2024-07-01 | $438.87 | $158.59 | RVU24C |
| 2024-04-01 | $438.87 | $158.59 | RVU24B |
| 2024-03-09 | $438.87 | $158.59 | RVU24AR |
| 2024-01-01 | $431.71 | $156.00 | RVU24A |
| 2023-10-01 | $451.26 | $160.17 | RVU23D |
| 2023-07-01 | $451.26 | $160.17 | RVU23C |
| 2023-04-01 | $451.26 | $160.17 | RVU23B |
| 2023-01-01 | $451.26 | $160.17 | RVU23A |
| 2022-10-01 | $473.96 | $162.85 | RVU22D |
| 2022-07-01 | $473.96 | $162.85 | RVU22C |
| 2022-04-01 | $473.96 | $162.85 | RVU22B |
| 2022-01-01 | $473.96 | $162.85 | RVU22A |
| 2021-10-01 | $473.12 | $163.97 | RVU21D |
| 2021-07-01 | $473.12 | $163.97 | RVU21C |
| 2021-04-01 | $473.12 | $163.97 | RVU21B |
| 2021-01-01 | $473.12 | $163.97 | RVU21A |
| 2020-10-01 | $435.67 | $168.25 | RVU20D |
| 2020-07-01 | $435.67 | $168.25 | RVU20C |
| 2020-04-01 | $435.67 | $168.25 | RVU20B |
| 2020-01-01 | $435.67 | $168.25 | RVU20A |
| 2019-10-01 | $415.13 | $168.99 | RVU19D |
| 2019-07-01 | $415.13 | $168.99 | RVU19C |
| 2019-04-01 | $415.13 | $168.99 | RVU19B |
| 2019-01-01 | $415.13 | $168.99 | RVU19A |
| 2018-10-01 | $398.26 | $170.02 | RVU18D |
| 2018-07-01 | $398.26 | $170.02 | RVU18C |
| 2018-04-01 | $398.26 | $170.02 | RVU18B |
| 2018-01-01 | $398.26 | $170.02 | RVU18AR1 |
| 2017-10-01 | $394.84 | $169.46 | RVU17D |
| 2017-07-01 | $394.84 | $169.46 | RVU17C |
| 2017-04-01 | $394.84 | $169.46 | RVU17B |
| 2017-01-01 | $394.84 | $169.46 | RVU17A |
| 2016-10-01 | $453.21 | $174.30 | RVU16D |
| 2016-07-01 | $453.21 | $174.30 | RVU16C |
| 2016-04-01 | $453.21 | $174.30 | RVU16B |
| 2016-01-01 | $453.21 | $174.30 | RVU16A |
| 2015-10-01 | $461.03 | $176.79 | RVU15D |
| 2015-07-01 | $461.03 | $176.79 | RVU15C |
| 2015-04-01 | $458.73 | $175.91 | RVU15B |
| 2015-01-01 | $458.73 | $175.91 | RVU15A |
| 2014-10-01 | $455.65 | $176.59 | RVU14D |
| 2014-07-01 | $455.65 | $176.59 | RVU14C |
| 2014-04-01 | $455.65 | $176.59 | RVU14B |
| 2014-01-01 | $455.65 | $176.59 | RVU14A |
| 2013-10-01 | Not available in this setting | $182.18 | RVU13D |
| 2013-07-01 | Not available in this setting | $182.18 | RVU13C |
| 2013-04-01 | Not available in this setting | $182.18 | RVU13B |
| 2013-01-01 | Not available in this setting | $182.18 | RVU13AR |
Where the South Dakota rate applies
South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Agar
- Agency Village
- Akaska
- Albee
- Alcester
- Alexandria
- Allen
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
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