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CPT code 43251: EGD lesion removal, snare technique2026 Medicare rate & RVUs in Miami, FL

Reports upper endoscopy with snare removal of a polyp or other lesion in the esophagus, stomach, or duodenum.

CMS RVU26DEffective Oct 1, 2026One payment locality64.4K Medicare services in 2024

In Miami, FL, Medicare pays $582.90 for 43251 in the office and $194.86 when it’s performed in a hospital or facility.

$582.90Office (non-facility)
$194.86Hospital or facility
+6.8%vs the national office rate ($545.77)

Check a contract rate as a % of Medicare · 43251 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 43251 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Miami, FL
  2. What 43251 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 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.

How Miami, FL compares for 43251

Across 109 of 109 payment localities, the office rate for 43251 runs from $480.25 in Arkansas to $737.72 in San Benito County, CA. Miami, FL pays $582.90. The RVUs are the same everywhere; the geographic indexes change the dollars.

43251 in Miami, FL vs other payment areas
  1. Miami, FL · this page$582.90
  2. Fort Lauderdale, FL · Florida$561.75−$21.15
  3. Rest of Florida · Florida$533.85−$49.05
  4. Los Angeles, CA · California$622.85+$39.95
  5. Washington, DC area · District of Columbia$628.07+$45.17
  6. Chicago, IL · Illinois$565.53−$17.37
  7. Manhattan, NY · New York$628.65+$45.75

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

Every other payment area

43251 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$623.66$226.68
AlabamaAlabama$487.64$161.48
ArkansasArkansas$480.25$160.06
ArizonaArizona$530.88$169.68
Bakersfield, CACalifornia$583.13$174.59
Chico, CACalifornia$581.95$173.41
El Centro, CACalifornia$582.02$173.48
Fresno, CACalifornia$581.95$173.41

43251 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.

$480.25

$659.84

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

View every state and territory as a table
43251 office rate range by state
State / territoryOffice rate rangeLocalities
AK$623.661
AL$487.641
AR$480.251
AZ$530.881
CA$581.95–$737.7229
CO$571.141
CT$583.091
DC$628.071
DE$539.981
FL$533.85–$582.903
GA$502.93–$555.452
GU$597.811
HI$597.811
IA$502.231
ID$505.321
IL$516.58–$567.954
IN$508.431
KS$499.001
KY$498.061
LA$496.94–$522.772
MA$567.18–$630.422
MD$550.87–$628.073
ME$507.26–$537.192
MI$510.92–$540.012
MN$548.781
MO$487.49–$525.643
MS$484.011
MT$545.741
NC$512.941
ND$538.031
NE$505.341
NH$561.361
NJ$590.18–$620.942
NM$513.541
NV$544.021
NY$520.91–$643.515
OH$509.351
OK$497.941
OR$540.22–$590.852
PA$510.63–$567.532
PR$550.191
RI$560.361
SC$511.911
SD$537.121
TN$501.531
TX$507.06–$568.868
UT$519.251
VA$534.80–$628.072
VI$550.191
VT$535.141
WA$566.38–$644.342
WI$519.121
WV$496.381
WY$542.381

See 43251 in every payment locality

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

Office or facility?

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.

The exact Miami, FL inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,180

Code
43251
Physician work
3.38
Practice expense
12.57
Malpractice
0.39

GPCI2026.csv

42

Locality
Miami, FL
Physician work
1.000
Practice expense
1.041
Malpractice
2.529
Office calculation for 43251 in Miami, FL
ComponentRVULocality factorAdjusted
Physician work3.38× 1.0003.3800
Practice expense12.57× 1.04113.0854
Malpractice0.39× 2.5290.9863
Total RVUs17.4517
Conversion factor× 33.4009

Office rate, Miami, FL$582.90

Office: (3.38 × 1 + 12.57 × 1.041 + 0.39 × 2.529) × $33.4009 = $582.90

Facility: (3.38 × 1 + 1.41 × 1.041 + 0.39 × 2.529) × $33.4009 = $194.86

Open 43251 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 43251

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

Codes related to 43251
CodeHow it relatesOffice range, Miami, FL
Used instead
43250Upper endoscopy, cautery lesion removalRemoves an upper-GI lesion with hot biopsy forceps or bipolar cautery rather than a snare.$536.02
43254Endoscopic resection, mucosal resectionUsed when the lesion is treated by endoscopic mucosal resection rather than snare removal.No office rate
43239EGD with biopsy, single or multiple biopsiesSamples upper-GI tissue by biopsy when the lesion is not removed by snare.$446.25

How 43251 has changed in Miami, FL

43251 · Office / nonfacility

$582.90

Effective 2026-10-01

The base rate is $84.75 higher than on 2025-10-01, moving from $498.15 to $582.90 (17.0%).

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

    $498.15changed to$582.90

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.47 changed to 3.38
    • Practice expense RVU 10.57 changed to 12.57
    • Malpractice RVU 0.43 changed to 0.39
    • Practice expense GPCI 1.027 changed to 1.041
    • Malpractice GPCI 2.500 changed to 2.529

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $523.09changed to$498.15

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.90 changed to 10.57
    • Malpractice RVU 0.42 changed to 0.43

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $514.55changed to$523.09

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $537.20changed to$514.55

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 11.03 changed to 10.90
    • Practice expense GPCI 1.025 changed to 1.027
    • Malpractice GPCI 2.564 changed to 2.500

  5. January 1, 2023

    RVU23A

    $561.48changed to$537.20

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 11.44 changed to 11.03
    • Malpractice RVU 0.40 changed to 0.42
    • Practice expense GPCI 1.023 changed to 1.025
    • Malpractice GPCI 2.629 changed to 2.564

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $559.50changed to$561.48

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 11.28 changed to 11.44
    • Malpractice RVU 0.39 changed to 0.40

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $522.28changed to$559.50

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.71 changed to 11.28
    • Malpractice RVU 0.40 changed to 0.39
    • Practice expense GPCI 1.026 changed to 1.023
    • Malpractice GPCI 2.598 changed to 2.629

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $505.43changed to$522.28

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 9.11 changed to 9.71
    • Malpractice RVU 0.46 changed to 0.40
    • Practice expense GPCI 1.029 changed to 1.026
    • Malpractice GPCI 2.566 changed to 2.598

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $488.39changed to$505.43

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 8.64 changed to 9.11
    • Malpractice RVU 0.47 changed to 0.46

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $483.37changed to$488.39

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.57 changed to 8.64
    • Malpractice RVU 0.46 changed to 0.47
    • Practice expense GPCI 1.031 changed to 1.029
    • Malpractice GPCI 2.528 changed to 2.566

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $544.54changed to$483.37

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.57 changed to 3.47
    • Practice expense RVU 10.11 changed to 8.57
    • Malpractice RVU 0.48 changed to 0.46
    • Practice expense GPCI 1.033 changed to 1.031
    • Malpractice GPCI 2.490 changed to 2.528

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $558.25changed to$544.54

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 10.33 changed to 10.11
    • Malpractice RVU 0.52 changed to 0.48

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $555.47changed to$558.25

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $559.52changed to$555.47

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 10.22 changed to 10.33
    • Practice expense GPCI 1.044 changed to 1.033
    • Malpractice GPCI 2.653 changed to 2.490

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$559.52

    Held through RVU14B, RVU14C, RVU14D.

  16. 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$582.90$194.86RVU26D
2026-07-01$582.90$194.86RVU26C
2026-04-01$582.90$194.86RVU26B
2026-01-01$582.90$194.86RVU26A
2025-10-01$498.15$210.13RVU25D
2025-07-01$498.15$210.13RVU25C
2025-04-01$498.15$210.13RVU25B
2025-01-01$498.15$210.13RVU25A
2024-10-01$523.09$215.07RVU24D
2024-07-01$523.09$215.07RVU24C
2024-04-01$523.09$215.07RVU24B
2024-03-09$523.09$215.07RVU24AR
2024-01-01$514.55$211.56RVU24A
2023-10-01$537.20$218.69RVU23D
2023-07-01$537.20$218.69RVU23C
2023-04-01$537.20$218.69RVU23B
2023-01-01$537.20$218.69RVU23A
2022-10-01$561.48$222.32RVU22D
2022-07-01$561.48$222.32RVU22C
2022-04-01$561.48$222.32RVU22B
2022-01-01$561.48$222.32RVU22A
2021-10-01$559.50$222.54RVU21D
2021-07-01$559.50$222.54RVU21C
2021-04-01$559.50$222.54RVU21B
2021-01-01$559.50$222.54RVU21A
2020-10-01$522.28$229.02RVU20D
2020-07-01$522.28$229.02RVU20C
2020-04-01$522.28$229.02RVU20B
2020-01-01$522.28$229.02RVU20A
2019-10-01$505.43$234.72RVU19D
2019-07-01$505.43$234.72RVU19C
2019-04-01$505.43$234.72RVU19B
2019-01-01$505.43$234.72RVU19A
2018-10-01$488.39$236.50RVU18D
2018-07-01$488.39$236.50RVU18C
2018-04-01$488.39$236.50RVU18B
2018-01-01$488.39$236.50RVU18AR1
2017-10-01$483.37$233.98RVU17D
2017-07-01$483.37$233.98RVU17C
2017-04-01$483.37$233.98RVU17B
2017-01-01$483.37$233.98RVU17A
2016-10-01$544.54$239.78RVU16D
2016-07-01$544.54$239.78RVU16C
2016-04-01$544.54$239.78RVU16B
2016-01-01$544.54$239.78RVU16A
2015-10-01$558.25$246.45RVU15D
2015-07-01$558.25$246.45RVU15C
2015-04-01$555.47$245.22RVU15B
2015-01-01$555.47$245.22RVU15A
2014-10-01$559.52$249.86RVU14D
2014-07-01$559.52$249.86RVU14C
2014-04-01$559.52$249.86RVU14B
2014-01-01$559.52$249.86RVU14A
2013-10-01Not available in this setting$260.22RVU13D
2013-07-01Not available in this setting$260.22RVU13C
2013-04-01Not available in this setting$260.22RVU13B
2013-01-01Not available in this setting$260.22RVU13AR

Price 43251 for an earlier date of service

Where the Miami, FL rate applies

Miami, FL is a Medicare payment area, not a city. Our Census mapping connects it to 83 cities and communities in Florida. Some span more than one payment area; confirm with the service ZIP.

  • Miami
  • Aventura
  • Bal Harbour
  • Bay Harbor Islands
  • Big Coppitt Key
  • Big Pine Key
  • Biscayne Gardens
  • Biscayne Park

Browse all communities in Florida

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
RVUs for 43251PPRRVU2026_Oct_nonQPP.csv, line 5,180 (RVU26D)
Geographic factors for Miami, FLGPCI2026.csv, line 42 (RVU26D)

Open CMS sourceHow we calculate rates

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