CPT code 43252: Optical endomicroscopy, during upper endoscopy2026 Medicare rate & RVUs in Montana
Reports optical endomicroscopic imaging performed during upper endoscopy to assess gastrointestinal mucosa at microscopic resolution in real time.
In Montana, Medicare pays $377.07 for 43252 in the office and $149.95 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 43252 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 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.
How Montana compares for 43252
Across 109 of 109 payment localities, the office rate for 43252 runs from $333.51 in Arkansas to $501.13 in San Benito County, CA. Montana pays $377.07. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$377.07
- Los Angeles, CA · California$426.33+$49.26
- Washington, DC area · District of Columbia$431.49+$54.42
- Miami, FL · Florida$405.99+$28.92
- Chicago, IL · Illinois$394.26+$17.19
- Manhattan, NY · New York$433.68+$56.61
- Alaska · Alaska$437.59+$60.52
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $338.41 | $139.68 |
| ArkansasArkansas | $333.51 | $138.41 |
| ArizonaArizona | $367.08 | $146.99 |
| Bakersfield, CACalifornia | $400.17 | $151.24 |
| Chico, CACalifornia | $399.13 | $150.19 |
| El Centro, CACalifornia | $399.18 | $150.25 |
| Fresno, CACalifornia | $399.13 | $150.19 |
| Hanford, CACalifornia | $399.13 | $150.19 |
| Madera, CACalifornia | $399.13 | $150.19 |
| Merced, CACalifornia | $399.13 | $150.19 |
| Modesto, CACalifornia | $399.13 | $150.19 |
| Napa, CACalifornia | $462.93 | $163.58 |
| Oxnard, CACalifornia | $424.33 | $155.86 |
| Redding, CACalifornia | $399.13 | $150.19 |
| Rest of CaliforniaCalifornia | $399.13 | $150.19 |
| Riverside, CACalifornia | $402.93 | $154.00 |
| Sacramento, CACalifornia | $418.97 | $154.83 |
| Salinas, CACalifornia | $417.42 | $154.18 |
| San Diego, CACalifornia | $427.34 | $155.69 |
| Marin County, CACalifornia | $490.18 | $169.93 |
| San Francisco, CACalifornia | $489.78 | $169.54 |
| San Benito County, CACalifornia | $501.13 | $173.62 |
| Santa Clara County, CACalifornia | $499.51 | $171.99 |
| San Luis Obispo, CACalifornia | $410.69 | $151.99 |
| Santa Cruz, CACalifornia | $431.51 | $155.55 |
| Santa Maria, CACalifornia | $419.01 | $154.18 |
| Santa Rosa, CACalifornia | $435.87 | $156.96 |
| Stockton, CACalifornia | $399.13 | $150.19 |
| Vallejo, CACalifornia | $462.36 | $163.00 |
| Visalia, CACalifornia | $399.13 | $150.19 |
| Yuba City, CACalifornia | $399.13 | $150.19 |
| ColoradoColorado | $392.90 | $151.24 |
| ConnecticutConnecticut | $402.19 | $157.57 |
| DelawareDelaware | $373.17 | $148.77 |
| Fort Lauderdale, FLFlorida | $390.04 | $159.96 |
| Rest of FloridaFlorida | $371.15 | $154.01 |
| Atlanta, GAGeorgia | $384.04 | $153.28 |
| Rest of GeorgiaGeorgia | $350.30 | $147.71 |
| Hawaii, Guam, HIHawaii | $409.01 | $150.77 |
| IowaIowa | $347.19 | $139.37 |
| IdahoIdaho | $349.43 | $140.47 |
| East St. Louis, ILIllinois | $367.44 | $158.48 |
| Rest of IllinoisIllinois | $360.29 | $152.92 |
| Suburban Chicago, ILIllinois | $394.06 | $160.80 |
| IndianaIndiana | $351.46 | $140.91 |
| KansasKansas | $345.49 | $140.16 |
| KentuckyKentucky | $346.26 | $144.34 |
| New Orleans, LALouisiana | $362.82 | $149.10 |
| Rest of LouisianaLouisiana | $345.68 | $144.68 |
| Metropolitan Boston, MAMassachusetts | $431.93 | $160.74 |
| Rest of MassachusettsMassachusetts | $390.52 | $151.35 |
| Baltimore area, MDMaryland | $401.04 | $157.33 |
| Rest of MarylandMaryland | $380.33 | $150.48 |
| Rest of MaineMaine | $351.17 | $142.21 |
| Southern Maine, MEMaine | $370.36 | $145.28 |
| Detroit, MIMichigan | $375.71 | $156.53 |
| Rest of MichiganMichigan | $355.21 | $147.85 |
| MinnesotaMinnesota | $376.66 | $142.95 |
| Metropolitan Kansas City, MOMissouri | $360.43 | $147.15 |
| Metropolitan St. Louis, MOMissouri | $364.21 | $147.99 |
| Rest of MissouriMissouri | $339.69 | $143.90 |
| MississippiMississippi | $336.67 | $141.12 |
| North CarolinaNorth Carolina | $354.86 | $142.95 |
| North DakotaNorth Dakota | $370.15 | $143.03 |
| NebraskaNebraska | $349.12 | $139.48 |
| New HampshireNew Hampshire | $386.66 | $150.22 |
| Northern New JerseyNew Jersey | $426.99 | $163.53 |
| Rest of New JerseyNew Jersey | $406.83 | $158.81 |
| New MexicoNew Mexico | $357.13 | $148.85 |
| NevadaNevada | $375.41 | $148.06 |
| NYC suburbs and Long Island, NYNew York | $444.11 | $174.06 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $409.44 | $160.74 |
| Queens, NYNew York | $437.38 | $168.91 |
| Rest of New YorkNew York | $360.18 | $144.41 |
| OhioOhio | $353.80 | $146.43 |
| OklahomaOklahoma | $345.72 | $142.90 |
| Portland, OROregon | $405.49 | $153.16 |
| Rest of OregonOregon | $372.55 | $146.33 |
| Metropolitan Philadelphia, PAPennsylvania | $392.11 | $155.68 |
| Rest of PennsylvaniaPennsylvania | $354.41 | $145.90 |
| Puerto RicoPuerto Rico | $379.88 | $150.25 |
| Rhode IslandRhode Island | $386.54 | $151.92 |
| South CarolinaSouth Carolina | $354.91 | $145.04 |
| South DakotaSouth Dakota | $369.33 | $142.21 |
| TennesseeTennessee | $347.22 | $140.76 |
| Austin, TXTexas | $391.55 | $151.25 |
| Beaumont, TXTexas | $352.07 | $145.38 |
| Brazoria, TXTexas | $372.88 | $147.79 |
| Dallas, TXTexas | $375.23 | $149.01 |
| Fort Worth, TXTexas | $372.69 | $148.75 |
| Galveston, TXTexas | $373.98 | $148.44 |
| Houston, TXTexas | $380.38 | $154.85 |
| Rest of TexasTexas | $362.25 | $146.71 |
| UtahUtah | $359.77 | $146.27 |
| VirginiaVirginia | $369.09 | $145.82 |
| Virgin Islands, VIUnited States Virgin Islands | $379.88 | $150.25 |
| VermontVermont | $368.63 | $143.78 |
| Rest of WashingtonWashington | $389.81 | $150.64 |
| King County, WAWashington | $440.82 | $162.13 |
| WisconsinWisconsin | $357.71 | $140.13 |
| West VirginiaWest Virginia | $346.91 | $149.54 |
| WyomingWyoming | $374.06 | $146.93 |
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.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,181
- Code
- 43252
- Physician work
- 2.89
- Practice expense
- 8.05
- Malpractice
- 0.35
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.89 | × 1.000 | 2.8900 |
| Practice expense | 8.05 | × 1.000 | 8.0500 |
| Malpractice | 0.35 | × 0.998 | 0.3493 |
| Total RVUs | 11.2893 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$377.07
Office: (2.89 × 1 + 8.05 × 1 + 0.35 × 0.998) × $33.4009 = $377.07
Facility: (2.89 × 1 + 1.25 × 1 + 0.35 × 0.998) × $33.4009 = $149.95
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%).
How 43252 has changed in Montana
43252 · Office / nonfacility
$377.07
Effective 2026-10-01
The base rate is $50.30 higher than on 2025-10-01, moving from $326.77 to $377.07 (15.4%).
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
$326.77changed to$377.07
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 2.96 changed to 2.89
- Practice expense RVU 6.79 changed to 8.05
- Malpractice RVU 0.36 changed to 0.35
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$338.60changed to$326.77
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 6.86 changed to 6.79
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$333.08changed to$338.60
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$344.03changed to$333.08
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 6.85 changed to 6.86
- Malpractice RVU 0.35 changed to 0.36
January 1, 2023
RVU23A
$357.21changed to$344.03
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 7.03 changed to 6.85
- Malpractice RVU 0.34 changed to 0.35
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$354.24changed to$357.21
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 6.86 changed to 7.03
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$337.89changed to$354.24
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 5.92 changed to 6.86
- Malpractice RVU 0.37 changed to 0.34
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$332.46changed to$337.89
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 5.58 changed to 5.92
- Malpractice RVU 0.42 changed to 0.37
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$320.71changed to$332.46
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 5.28 changed to 5.58
- Malpractice RVU 0.41 changed to 0.42
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$314.24changed to$320.71
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 5.21 changed to 5.28
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$376.92changed to$314.24
- Conversion factor 35.8043 changed to 35.8887
- Work RVU 3.06 changed to 2.96
- Practice expense RVU 6.94 changed to 5.21
- Malpractice RVU 0.43 changed to 0.41
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$384.43changed to$376.92
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 7.05 changed to 6.94
- Malpractice RVU 0.48 changed to 0.43
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$382.52changed to$384.43
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$378.62changed to$382.52
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 7.02 changed to 7.05
- Malpractice RVU 0.42 changed to 0.48
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$378.62
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 | $377.07 | $149.95 | RVU26D |
| 2026-07-01 | $377.07 | $149.95 | RVU26C |
| 2026-04-01 | $377.07 | $149.95 | RVU26B |
| 2026-01-01 | $377.07 | $149.95 | RVU26A |
| 2025-10-01 | $326.77 | $160.83 | RVU25D |
| 2025-07-01 | $326.77 | $160.83 | RVU25C |
| 2025-04-01 | $326.77 | $160.83 | RVU25B |
| 2025-01-01 | $326.77 | $160.83 | RVU25A |
| 2024-10-01 | $338.60 | $165.18 | RVU24D |
| 2024-07-01 | $338.60 | $165.18 | RVU24C |
| 2024-04-01 | $338.60 | $165.18 | RVU24B |
| 2024-03-09 | $338.60 | $165.18 | RVU24AR |
| 2024-01-01 | $333.08 | $162.48 | RVU24A |
| 2023-10-01 | $344.03 | $166.80 | RVU23D |
| 2023-07-01 | $344.03 | $166.80 | RVU23C |
| 2023-04-01 | $344.03 | $166.80 | RVU23B |
| 2023-01-01 | $344.03 | $166.80 | RVU23A |
| 2022-10-01 | $357.21 | $169.99 | RVU22D |
| 2022-07-01 | $357.21 | $169.99 | RVU22C |
| 2022-04-01 | $357.21 | $169.99 | RVU22B |
| 2022-01-01 | $357.21 | $169.99 | RVU22A |
| 2021-10-01 | $354.24 | $170.70 | RVU21D |
| 2021-07-01 | $354.24 | $170.70 | RVU21C |
| 2021-04-01 | $354.24 | $170.70 | RVU21B |
| 2021-01-01 | $354.24 | $170.70 | RVU21A |
| 2020-10-01 | $337.89 | $180.18 | RVU20D |
| 2020-07-01 | $337.89 | $180.18 | RVU20C |
| 2020-04-01 | $337.89 | $180.18 | RVU20B |
| 2020-01-01 | $337.89 | $180.18 | RVU20A |
| 2019-10-01 | $332.46 | $187.94 | RVU19D |
| 2019-07-01 | $332.46 | $187.94 | RVU19C |
| 2019-04-01 | $332.46 | $187.94 | RVU19B |
| 2019-01-01 | $332.46 | $187.94 | RVU19A |
| 2018-10-01 | $320.71 | $187.51 | RVU18D |
| 2018-07-01 | $320.71 | $187.51 | RVU18C |
| 2018-04-01 | $320.71 | $187.51 | RVU18B |
| 2018-01-01 | $320.71 | $187.51 | RVU18AR1 |
| 2017-10-01 | $314.24 | $183.96 | RVU17D |
| 2017-07-01 | $314.24 | $183.96 | RVU17C |
| 2017-04-01 | $314.24 | $183.96 | RVU17B |
| 2017-01-01 | $314.24 | $183.96 | RVU17A |
| 2016-10-01 | $376.92 | $185.72 | RVU16D |
| 2016-07-01 | $376.92 | $185.72 | RVU16C |
| 2016-04-01 | $376.92 | $185.72 | RVU16B |
| 2016-01-01 | $376.92 | $185.72 | RVU16A |
| 2015-10-01 | $384.43 | $191.11 | RVU15D |
| 2015-07-01 | $384.43 | $191.11 | RVU15C |
| 2015-04-01 | $382.52 | $190.16 | RVU15B |
| 2015-01-01 | $382.52 | $190.16 | RVU15A |
| 2014-10-01 | $378.62 | $188.40 | RVU14D |
| 2014-07-01 | $378.62 | $188.40 | RVU14C |
| 2014-04-01 | $378.62 | $188.40 | RVU14B |
| 2014-01-01 | $378.62 | $188.40 | RVU14A |
| 2013-10-01 | Contractor-priced | Contractor-priced | RVU13D |
| 2013-07-01 | Contractor-priced | Contractor-priced | RVU13C |
| 2013-04-01 | Contractor-priced | Contractor-priced | RVU13B |
| 2013-01-01 | Contractor-priced | Contractor-priced | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
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
Show the CMS file lines behind this rate
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