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

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 Vermont, Medicare pays $535.14 for 43251 in the office and $166.11 when it’s performed in a hospital or facility.

$535.14Office (non-facility)
$166.11Hospital or facility
−1.9%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 Vermont
  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 Vermont 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. Vermont pays $535.14. The RVUs are the same everywhere; the geographic indexes change the dollars.

43251 in Vermont vs other payment areas
  1. Vermont · this page$535.14
  2. Los Angeles, CA · California$622.85+$87.71
  3. Washington, DC area · District of Columbia$628.07+$92.93
  4. Miami, FL · Florida$582.90+$47.76
  5. Chicago, IL · Illinois$565.53+$30.39
  6. Manhattan, NY · New York$628.65+$93.51
  7. Alaska · Alaska$623.66+$88.52

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

Every other payment area

43251 in every other Medicare payment locality
Payment localityOfficeFacility
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
Hanford, 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 Vermont 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

105

Locality
Vermont
Physician work
1.000
Practice expense
0.990
Malpractice
0.506
Office calculation for 43251 in Vermont
ComponentRVULocality factorAdjusted
Physician work3.38× 1.0003.3800
Practice expense12.57× 0.99012.4443
Malpractice0.39× 0.5060.1973
Total RVUs16.0216
Conversion factor× 33.4009

Office rate, Vermont$535.14

Office: (3.38 × 1 + 12.57 × 0.99 + 0.39 × 0.506) × $33.4009 = $535.14

Facility: (3.38 × 1 + 1.41 × 0.99 + 0.39 × 0.506) × $33.4009 = $166.11

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, Vermont
Used instead
43250Upper endoscopy, cautery lesion removalRemoves an upper-GI lesion with hot biopsy forceps or bipolar cautery rather than a snare.$487.87
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.$411.07

How 43251 has changed in Vermont

43251 · Office / nonfacility

$535.14

Effective 2026-10-01

The base rate is $76.18 higher than on 2025-10-01, moving from $458.96 to $535.14 (16.6%).

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

    $458.96changed to$535.14

    • 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 0.993 changed to 0.990
    • Malpractice GPCI 0.518 changed to 0.506

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $483.04changed to$458.96

    • 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

    $475.16changed to$483.04

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $497.97changed to$475.16

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 11.03 changed to 10.90
    • Practice expense GPCI 0.997 changed to 0.993
    • Malpractice GPCI 0.543 changed to 0.518

  5. January 1, 2023

    RVU23A

    $524.25changed to$497.97

    • 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 1.001 changed to 0.997
    • Malpractice GPCI 0.569 changed to 0.543

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $522.81changed to$524.25

    • 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

    $486.87changed to$522.81

    • 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 1.008 changed to 1.001
    • Malpractice GPCI 0.582 changed to 0.569

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $468.16changed to$486.87

    • 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 1.015 changed to 1.008
    • Malpractice GPCI 0.595 changed to 0.582

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $450.69changed to$468.16

    • 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

    $445.72changed to$450.69

    • 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 1.010 changed to 1.015
    • Malpractice GPCI 0.639 changed to 0.595

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $502.97changed to$445.72

    • 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 1.004 changed to 1.010
    • Malpractice GPCI 0.682 changed to 0.639

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $513.70changed to$502.97

    • 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

    $511.15changed to$513.70

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $507.71changed to$511.15

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 10.22 changed to 10.33
    • Practice expense GPCI 1.006 changed to 1.004
    • Malpractice GPCI 0.618 changed to 0.682

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$507.71

    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$535.14$166.11RVU26D
2026-07-01$535.14$166.11RVU26C
2026-04-01$535.14$166.11RVU26B
2026-01-01$535.14$166.11RVU26A
2025-10-01$458.96$180.48RVU25D
2025-07-01$458.96$180.48RVU25C
2025-04-01$458.96$180.48RVU25B
2025-01-01$458.96$180.48RVU25A
2024-10-01$483.04$185.22RVU24D
2024-07-01$483.04$185.22RVU24C
2024-04-01$483.04$185.22RVU24B
2024-03-09$483.04$185.22RVU24AR
2024-01-01$475.16$182.20RVU24A
2023-10-01$497.97$188.16RVU23D
2023-07-01$497.97$188.16RVU23C
2023-04-01$497.97$188.16RVU23B
2023-01-01$497.97$188.16RVU23A
2022-10-01$524.25$192.39RVU22D
2022-07-01$524.25$192.39RVU22C
2022-04-01$524.25$192.39RVU22B
2022-01-01$524.25$192.39RVU22A
2021-10-01$522.81$193.09RVU21D
2021-07-01$522.81$193.09RVU21C
2021-04-01$522.81$193.09RVU21B
2021-01-01$522.81$193.09RVU21A
2020-10-01$486.87$198.75RVU20D
2020-07-01$486.87$198.75RVU20C
2020-04-01$486.87$198.75RVU20B
2020-01-01$486.87$198.75RVU20A
2019-10-01$468.16$201.13RVU19D
2019-07-01$468.16$201.13RVU19C
2019-04-01$468.16$201.13RVU19B
2019-01-01$468.16$201.13RVU19A
2018-10-01$450.69$202.22RVU18D
2018-07-01$450.69$202.22RVU18C
2018-04-01$450.69$202.22RVU18B
2018-01-01$450.69$202.22RVU18AR1
2017-10-01$445.72$201.42RVU17D
2017-07-01$445.72$201.42RVU17C
2017-04-01$445.72$201.42RVU17B
2017-01-01$445.72$201.42RVU17A
2016-10-01$502.97$206.76RVU16D
2016-07-01$502.97$206.76RVU16C
2016-04-01$502.97$206.76RVU16B
2016-01-01$502.97$206.76RVU16A
2015-10-01$513.70$210.66RVU15D
2015-07-01$513.70$210.66RVU15C
2015-04-01$511.15$209.61RVU15B
2015-01-01$511.15$209.61RVU15A
2014-10-01$507.71$209.31RVU14D
2014-07-01$507.71$209.31RVU14C
2014-04-01$507.71$209.31RVU14B
2014-01-01$507.71$209.31RVU14A
2013-10-01Not available in this settingRate data unavailableRVU13D
2013-07-01Not available in this settingRate data unavailableRVU13C
2013-04-01Not available in this settingRate data unavailableRVU13B
2013-01-01Not available in this settingRate data unavailableRVU13AR

Price 43251 for an earlier date of service

Where the Vermont rate applies

Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.

  • Albany
  • Alburgh
  • Algiers
  • Arlington
  • Ascutney
  • Bakersfield
  • Barnet
  • Barre

Browse all communities in Vermont

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 VermontGPCI2026.csv, line 105 (RVU26D)

Open CMS sourceHow we calculate rates

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