CPT code 43251: EGD lesion removal, snare technique2026 Medicare rate & RVUs in California
Reports upper endoscopy with snare removal of a polyp or other lesion in the esophagus, stomach, or duodenum.
Medicare pays $581.95–$737.72 for 43251 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 43251 covers
A gastroenterologist or other qualified endoscopist uses a flexible upper endoscope and a snare to remove a polyp or other lesion from the esophagus, stomach, or duodenum. The service is commonly performed in a hospital outpatient department or an ambulatory endoscopy center, with the removed tissue typically sent for pathology. The defining feature is removal by snare, rather than sampling alone or removal by a different method.
Report the service for the snare removal performed during the EGD, not once for each lesion removed in the same session. The procedure report should identify the lesion site and describe its removal technique and the findings. 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. The assistant-at-surgery statutory restriction means Medicare does not pay an assistant for this procedure; 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 43251 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
$581.95 to $737.72
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $583.13 | $174.59 |
| Chico, CA | $581.95 | $173.41 |
| El Centro, CA | $582.02 | $173.48 |
| Fresno, CA | $581.95 | $173.41 |
| Hanford, CA | $581.95 | $173.41 |
| Los Angeles, CA | $622.85 | $181.89 |
| Madera, CA | $581.95 | $173.41 |
| Marin County, CA | $721.59 | $196.00 |
| Merced, CA | $581.95 | $173.41 |
| Modesto, CA | $581.95 | $173.41 |
| Napa, CA | $679.99 | $188.70 |
| Oxnard, CA | $620.43 | $179.84 |
| Redding, CA | $581.95 | $173.41 |
| Rest of California | $581.95 | $173.41 |
| Riverside, CA | $586.19 | $177.66 |
| Sacramento, CA | $612.23 | $178.71 |
| Salinas, CA | $609.98 | $177.96 |
| San Benito County, CA | $737.72 | $200.21 |
| San Diego, CA | $625.48 | $179.67 |
| San Francisco, CA | $721.14 | $195.56 |
| San Luis Obispo, CA | $600.00 | $175.44 |
| Santa Clara County, CA | $735.91 | $198.40 |
| Santa Cruz, CA | $632.36 | $179.47 |
| Santa Maria, CA | $612.58 | $177.95 |
| Santa Rosa, CA | $638.84 | $181.10 |
| Stockton, CA | $581.95 | $173.41 |
| Vallejo, CA | $679.35 | $188.06 |
| Visalia, CA | $581.95 | $173.41 |
| Yuba City, CA | $581.95 | $173.41 |
How the 43251 rate is calculated
Each of 43251’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 · 43251
RVUs × geographic indexes × conversion factor
Work3.38
3.38 RVUs× 1.000 GPCI
Practice expense12.57
12.57 RVUs× 1.000 GPCI
Malpractice0.39
0.39 RVUs× 1.000 GPCI
Adjusted RVUs
16.3400
Conversion factor
$33.4009
Medicare rate
$545.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43251
The CMS indicators that decide how 43251 is paid alongside other services.
CMS payment indicators · 43251
EGD lesion removal, snare technique
| 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
43251 without 51 · national office
$545.77
EGD lesion removal, snare technique
43251-51 · Second procedure: 50%
$272.89
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%).
43251 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43250Upper endoscopyCautery lesion removal
- Choose 43251 for snare removal. Choose 43250 when the lesion is removed with hot biopsy forceps or bipolar cautery.
- 43254Endoscopic resectionMucosal resection
- 43254 describes endoscopic mucosal resection. Use 43251 when the documented removal is by snare and is not an EMR.
- 43239EGD with biopsySingle or multiple biopsies
- 43239 is for biopsy sampling. This code is for removing a lesion with a snare, not merely taking tissue samples.
43251 billing questions
When should this code be used instead of 43239?
Use this code when a snare is used to remove the lesion. Code 43239 describes biopsy sampling rather than snare removal.
Is the code reported once for each polyp?
No. Report the snare-removal service once for the EGD session, even when more than one lesion is removed by snare.
How does this differ from 43250?
This code describes snare removal. Code 43250 is used when a lesion is removed with hot biopsy forceps or bipolar cautery.
Can a separate biopsy code be reported during the same EGD?
A biopsy code describes sampling, while this code describes snare removal. Document each service and lesion clearly; do not assume both are separately reportable for the same lesion.
Can modifier 50 be used for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; the anatomy or descriptor does not support modifier 50.
Does Medicare pay an assistant or co-surgeon for this procedure?
The assistant-at-surgery statutory restriction prevents Medicare payment for an assistant. 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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