CPT code 43252: Optical endomicroscopy, during upper endoscopy2026 Medicare rate & RVUs
Reports optical endomicroscopic imaging performed during upper endoscopy to assess gastrointestinal mucosa at microscopic resolution in real time.
Medicare pays $377.10 for 43252 nationally in the office and $149.97 in a hospital or facility. Local office rates run $333.51–$501.13.
Medicare rate · 43252
Optical endomicroscopy, during upper endoscopy
- Work RVUs
- 2.89
- Total RVUs
- 11.29
- Global days
- 000
National rate · 2026
$377.10
Office setting, before claim adjustments.
See every locality for 43252 →Billed by an NP, PA or therapist? →
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 10 sections
What 43252 covers
During an upper gastrointestinal endoscopy, the endoscopist uses optical endomicroscopy to examine selected mucosal areas at microscopic resolution while viewing the tissue in real time. The technique can help characterize suspicious mucosal changes, including areas evaluated during Barrett esophagus surveillance. Gastroenterologists typically perform it in a hospital or ambulatory endoscopy setting as part of an EGD; it is not a tissue specimen examination by pathology.
Report this code when optical endomicroscopy is performed during the EGD, and document the areas examined and the imaging service. When related endoscopies are performed together, CMS applies endoscopy-family pricing rather than pricing each as an unrelated standalone procedure. The 0-day global period includes same-day preoperative and postoperative care. CMS does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted. Modifier 50 is inappropriate for this code.
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 43252 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$333.51 to $501.13
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $338.41 | $139.68 |
| Alaska | $437.59 | $195.70 |
| Arizona | $367.08 | $146.99 |
| Arkansas | $333.51 | $138.41 |
| Atlanta, GA | $384.04 | $153.28 |
| Austin, TX | $391.55 | $151.25 |
| Bakersfield, CA | $400.17 | $151.24 |
| Baltimore area, MD | $401.04 | $157.33 |
| Beaumont, TX | $352.07 | $145.38 |
| Brazoria, TX | $372.88 | $147.79 |
| Chicago, IL | $394.26 | $165.99 |
| Chico, CA | $399.13 | $150.19 |
| Colorado | $392.90 | $151.24 |
| Connecticut | $402.19 | $157.57 |
| Dallas, TX | $375.23 | $149.01 |
| Delaware | $373.17 | $148.77 |
| Detroit, MI | $375.71 | $156.53 |
| East St. Louis, IL | $367.44 | $158.48 |
| El Centro, CA | $399.18 | $150.25 |
| Fort Lauderdale, FL | $390.04 | $159.96 |
| Fort Worth, TX | $372.69 | $148.75 |
| Fresno, CA | $399.13 | $150.19 |
| Galveston, TX | $373.98 | $148.44 |
| Hanford, CA | $399.13 | $150.19 |
| Hawaii, Guam, HI | $409.01 | $150.77 |
| Houston, TX | $380.38 | $154.85 |
| Idaho | $349.43 | $140.47 |
| Indiana | $351.46 | $140.91 |
| Iowa | $347.19 | $139.37 |
| Kansas | $345.49 | $140.16 |
| Kentucky | $346.26 | $144.34 |
| King County, WA | $440.82 | $162.13 |
| Los Angeles, CA | $426.33 | $157.64 |
| Madera, CA | $399.13 | $150.19 |
| Manhattan, NY | $433.68 | $169.76 |
| Marin County, CA | $490.18 | $169.93 |
| Merced, CA | $399.13 | $150.19 |
| Metropolitan Boston, MA | $431.93 | $160.74 |
| Metropolitan Kansas City, MO | $360.43 | $147.15 |
| Metropolitan Philadelphia, PA | $392.11 | $155.68 |
| Metropolitan St. Louis, MO | $364.21 | $147.99 |
| Miami, FL | $405.99 | $169.56 |
| Minnesota | $376.66 | $142.95 |
| Mississippi | $336.67 | $141.12 |
| Modesto, CA | $399.13 | $150.19 |
| Montana | $377.07 | $149.95 |
| Napa, CA | $462.93 | $163.58 |
| Nebraska | $349.12 | $139.48 |
| Nevada | $375.41 | $148.06 |
| New Hampshire | $386.66 | $150.22 |
| New Mexico | $357.13 | $148.85 |
| New Orleans, LA | $362.82 | $149.10 |
| North Carolina | $354.86 | $142.95 |
| North Dakota | $370.15 | $143.03 |
| Northern New Jersey | $426.99 | $163.53 |
| NYC suburbs and Long Island, NY | $444.11 | $174.06 |
| Ohio | $353.80 | $146.43 |
| Oklahoma | $345.72 | $142.90 |
| Oxnard, CA | $424.33 | $155.86 |
| Portland, OR | $405.49 | $153.16 |
| Poughkeepsie and northern NYC suburbs, NY | $409.44 | $160.74 |
| Puerto Rico | $379.88 | $150.25 |
| Queens, NY | $437.38 | $168.91 |
| Redding, CA | $399.13 | $150.19 |
| Rest of California | $399.13 | $150.19 |
| Rest of Florida | $371.15 | $154.01 |
| Rest of Georgia | $350.30 | $147.71 |
| Rest of Illinois | $360.29 | $152.92 |
| Rest of Louisiana | $345.68 | $144.68 |
| Rest of Maine | $351.17 | $142.21 |
| Rest of Maryland | $380.33 | $150.48 |
| Rest of Massachusetts | $390.52 | $151.35 |
| Rest of Michigan | $355.21 | $147.85 |
| Rest of Missouri | $339.69 | $143.90 |
| Rest of New Jersey | $406.83 | $158.81 |
| Rest of New York | $360.18 | $144.41 |
| Rest of Oregon | $372.55 | $146.33 |
| Rest of Pennsylvania | $354.41 | $145.90 |
| Rest of Texas | $362.25 | $146.71 |
| Rest of Washington | $389.81 | $150.64 |
| Rhode Island | $386.54 | $151.92 |
| Riverside, CA | $402.93 | $154.00 |
| Sacramento, CA | $418.97 | $154.83 |
| Salinas, CA | $417.42 | $154.18 |
| San Benito County, CA | $501.13 | $173.62 |
| San Diego, CA | $427.34 | $155.69 |
| San Francisco, CA | $489.78 | $169.54 |
| San Luis Obispo, CA | $410.69 | $151.99 |
| Santa Clara County, CA | $499.51 | $171.99 |
| Santa Cruz, CA | $431.51 | $155.55 |
| Santa Maria, CA | $419.01 | $154.18 |
| Santa Rosa, CA | $435.87 | $156.96 |
| South Carolina | $354.91 | $145.04 |
| South Dakota | $369.33 | $142.21 |
| Southern Maine, ME | $370.36 | $145.28 |
| Stockton, CA | $399.13 | $150.19 |
| Suburban Chicago, IL | $394.06 | $160.80 |
| Tennessee | $347.22 | $140.76 |
| Utah | $359.77 | $146.27 |
| Vallejo, CA | $462.36 | $163.00 |
| Vermont | $368.63 | $143.78 |
| Virgin Islands, VI | $379.88 | $150.25 |
| Virginia | $369.09 | $145.82 |
| Visalia, CA | $399.13 | $150.19 |
| Washington, DC area | $431.49 | $163.94 |
| West Virginia | $346.91 | $149.54 |
| Wisconsin | $357.71 | $140.13 |
| Wyoming | $374.06 | $146.93 |
| Yuba City, CA | $399.13 | $150.19 |
43252 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.
$333.51
$450.13
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 | $437.59 | 1 |
| AL | $338.41 | 1 |
| AR | $333.51 | 1 |
| AZ | $367.08 | 1 |
| CA | $399.13–$501.13 | 29 |
| CO | $392.90 | 1 |
| CT | $402.19 | 1 |
| DC | $431.49 | 1 |
| DE | $373.17 | 1 |
| FL | $371.15–$405.99 | 3 |
| GA | $350.30–$384.04 | 2 |
| GU | $409.01 | 1 |
| HI | $409.01 | 1 |
| IA | $347.19 | 1 |
| ID | $349.43 | 1 |
| IL | $360.29–$394.26 | 4 |
| IN | $351.46 | 1 |
| KS | $345.49 | 1 |
| KY | $346.26 | 1 |
| LA | $345.68–$362.82 | 2 |
| MA | $390.52–$431.93 | 2 |
| MD | $380.33–$431.49 | 3 |
| ME | $351.17–$370.36 | 2 |
| MI | $355.21–$375.71 | 2 |
| MN | $376.66 | 1 |
| MO | $339.69–$364.21 | 3 |
| MS | $336.67 | 1 |
| MT | $377.07 | 1 |
| NC | $354.86 | 1 |
| ND | $370.15 | 1 |
| NE | $349.12 | 1 |
| NH | $386.66 | 1 |
| NJ | $406.83–$426.99 | 2 |
| NM | $357.13 | 1 |
| NV | $375.41 | 1 |
| NY | $360.18–$444.11 | 5 |
| OH | $353.80 | 1 |
| OK | $345.72 | 1 |
| OR | $372.55–$405.49 | 2 |
| PA | $354.41–$392.11 | 2 |
| PR | $379.88 | 1 |
| RI | $386.54 | 1 |
| SC | $354.91 | 1 |
| SD | $369.33 | 1 |
| TN | $347.22 | 1 |
| TX | $352.07–$391.55 | 8 |
| UT | $359.77 | 1 |
| VA | $369.09–$431.49 | 2 |
| VI | $379.88 | 1 |
| VT | $368.63 | 1 |
| WA | $389.81–$440.82 | 2 |
| WI | $357.71 | 1 |
| WV | $346.91 | 1 |
| WY | $374.06 | 1 |
How the 43252 rate is calculated
Each of 43252’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 · 43252
RVUs × geographic indexes × conversion factor
Work2.89
2.89 RVUs× 1.000 GPCI
Practice expense8.05
8.05 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
11.2900
Conversion factor
$33.4009
Medicare rate
$377.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43252
The CMS indicators that decide how 43252 is paid alongside other services.
CMS payment indicators · 43252
Optical endomicroscopy, during upper endoscopy
| 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
43252 without 51 · national office
$377.10
Optical endomicroscopy, during upper endoscopy
43252-51 · Second procedure: 50%
$188.55
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%).
43252 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43239EGD with biopsySingle or multiple biopsies
- Choose 43252 for optical endomicroscopic imaging; choose 43239 when the endoscopist obtains mucosal tissue for examination.
- 43259Endoscopic ultrasoundDiagnostic examination
- Code 43259 describes endoscopic ultrasound examination of the specified upper gastrointestinal anatomy. Code 43252 uses optical imaging to assess mucosa at microscopic resolution.
- 43254Endoscopic resectionMucosal resection
- Code 43254 describes endoscopic mucosal resection of a lesion. Code 43252 describes optical imaging, not lesion removal.
43252 billing questions
How is this different from EGD with biopsy, 43239?
This code describes real-time optical microscopic imaging of mucosa. Code 43239 describes obtaining tissue for histologic examination; imaging alone is not a biopsy.
Can biopsy or lesion treatment also be reported at the same session?
A separately performed biopsy or therapeutic service may have its own code, but document the distinct service and apply applicable coding and endoscopy-family pricing rules.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inapplicable and modifier 50 as inappropriate for this service.
Is an assistant surgeon payable?
CMS lists a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are not permitted.
What same-day care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care.
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
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