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CPT code 43252: Optical endomicroscopy, during upper endoscopy2026 Medicare rate & RVUs in Puerto Rico

Reports optical endomicroscopic imaging performed during upper endoscopy to assess gastrointestinal mucosa at microscopic resolution in real time.

CMS RVU26DEffective Oct 1, 2026One payment locality4.5K Medicare services in 2024

In Puerto Rico, Medicare pays $379.88 for 43252 in the office and $150.25 when it’s performed in a hospital or facility.

$379.88Office (non-facility)
$150.25Hospital or facility
+0.7%vs the national office rate ($377.10)

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.

We’ll open 43252 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 43252 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 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 Puerto Rico 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. Puerto Rico pays $379.88. The RVUs are the same everywhere; the geographic indexes change the dollars.

43252 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$379.88
  2. Los Angeles, CA · California$426.33+$46.45
  3. Washington, DC area · District of Columbia$431.49+$51.61
  4. Miami, FL · Florida$405.99+$26.11
  5. Chicago, IL · Illinois$394.26+$14.38
  6. Manhattan, NY · New York$433.68+$53.80
  7. Alaska · Alaska$437.59+$57.71

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

Every other payment area

43252 in every other Medicare payment locality
Payment localityOfficeFacility
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

43252 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.

$333.51

$450.13

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

View every state and territory as a table
43252 office rate range by state
State / territoryOffice rate rangeLocalities
AK$437.591
AL$338.411
AR$333.511
AZ$367.081
CA$399.13–$501.1329
CO$392.901
CT$402.191
DC$431.491
DE$373.171
FL$371.15–$405.993
GA$350.30–$384.042
GU$409.011
HI$409.011
IA$347.191
ID$349.431
IL$360.29–$394.264
IN$351.461
KS$345.491
KY$346.261
LA$345.68–$362.822
MA$390.52–$431.932
MD$380.33–$431.493
ME$351.17–$370.362
MI$355.21–$375.712
MN$376.661
MO$339.69–$364.213
MS$336.671
MT$377.071
NC$354.861
ND$370.151
NE$349.121
NH$386.661
NJ$406.83–$426.992
NM$357.131
NV$375.411
NY$360.18–$444.115
OH$353.801
OK$345.721
OR$372.55–$405.492
PA$354.41–$392.112
PR$379.881
RI$386.541
SC$354.911
SD$369.331
TN$347.221
TX$352.07–$391.558
UT$359.771
VA$369.09–$431.492
VI$379.881
VT$368.631
WA$389.81–$440.822
WI$357.711
WV$346.911
WY$374.061

See 43252 in every payment locality

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

Office or facility?

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 43252 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.89× 1.0002.8900
Practice expense8.05× 1.0118.1386
Malpractice0.35× 0.9850.3448
Total RVUs11.3733
Conversion factor× 33.4009

Office rate, Puerto Rico$379.88

Office: (2.89 × 1 + 8.05 × 1.011 + 0.35 × 0.985) × $33.4009 = $379.88

Facility: (2.89 × 1 + 1.25 × 1.011 + 0.35 × 0.985) × $33.4009 = $150.25

Open 43252 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 43252

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

Codes related to 43252
CodeHow it relatesOffice range, Puerto Rico
Often billed with
43239EGD with biopsy, single or multiple biopsiesMay accompany optical imaging when a separate upper endoscopic biopsy is performed and reporting rules permit.$422.36
43254Endoscopic resection, mucosal resectionMay be relevant in the same session when a distinct mucosal lesion resection is performed.No office rate
43242EUS-guided biopsy, intramural or transmural samplingAn ultrasound-guided needle sampling service may be performed during an upper endoscopy when clinically indicated.No office rate
Used instead
43259Endoscopic ultrasound, diagnostic examinationProvides endoscopic ultrasound examination rather than optical microscopic mucosal imaging.No office rate

How 43252 has changed in Puerto Rico

43252 · Office / nonfacility

$379.88

Effective 2026-10-01

The base rate is $51.53 higher than on 2025-10-01, moving from $328.35 to $379.88 (15.7%).

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

    $328.35changed to$379.88

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $340.25changed to$328.35

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.86 changed to 6.79

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $334.70changed to$340.25

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $345.96changed to$334.70

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $344.29changed to$345.96

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $359.26changed to$344.29

    • 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
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $356.26changed to$359.26

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.86 changed to 7.03

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $335.38changed to$356.26

    • 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 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $324.17changed to$335.38

    • 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
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $312.58changed to$324.17

    • 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.

  11. January 1, 2018

    RVU18AR1

    $275.73changed to$312.58

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.21 changed to 5.28
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $289.25changed to$275.73

    • 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
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $293.61changed to$289.25

    • 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.

  14. July 1, 2015

    RVU15C

    $292.15changed to$293.61

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $287.72changed to$292.15

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    No ratechanged to$287.72

    Held through RVU14B, RVU14C, RVU14D.

  17. 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$379.88$150.25RVU26D
2026-07-01$379.88$150.25RVU26C
2026-04-01$379.88$150.25RVU26B
2026-01-01$379.88$150.25RVU26A
2025-10-01$328.35$161.25RVU25D
2025-07-01$328.35$161.25RVU25C
2025-04-01$328.35$161.25RVU25B
2025-01-01$328.35$161.25RVU25A
2024-10-01$340.25$165.61RVU24D
2024-07-01$340.25$165.61RVU24C
2024-04-01$340.25$165.61RVU24B
2024-03-09$340.25$165.61RVU24AR
2024-01-01$334.70$162.90RVU24A
2023-10-01$345.96$167.31RVU23D
2023-07-01$344.29$167.06RVU23C
2023-04-01$344.29$167.06RVU23B
2023-01-01$344.29$167.06RVU23A
2022-10-01$359.26$170.55RVU22D
2022-07-01$359.26$170.55RVU22C
2022-04-01$359.26$170.55RVU22B
2022-01-01$359.26$170.55RVU22A
2021-10-01$356.26$171.26RVU21D
2021-07-01$356.26$171.26RVU21C
2021-04-01$356.26$171.26RVU21B
2021-01-01$356.26$171.26RVU21A
2020-10-01$335.38$176.40RVU20D
2020-07-01$335.38$176.40RVU20C
2020-04-01$335.38$176.40RVU20B
2020-01-01$335.38$176.40RVU20A
2019-10-01$324.17$178.64RVU19D
2019-07-01$324.17$178.64RVU19C
2019-04-01$324.17$178.64RVU19B
2019-01-01$324.17$178.64RVU19A
2018-10-01$312.58$178.45RVU18D
2018-07-01$312.58$178.45RVU18C
2018-04-01$312.58$178.45RVU18B
2018-01-01$312.58$178.45RVU18AR1
2017-10-01$275.73$164.22RVU17D
2017-07-01$275.73$164.22RVU17C
2017-04-01$275.73$164.22RVU17B
2017-01-01$275.73$164.22RVU17A
2016-10-01$289.25$154.46RVU16D
2016-07-01$289.25$154.46RVU16C
2016-04-01$289.25$154.46RVU16B
2016-01-01$289.25$154.46RVU16A
2015-10-01$293.61$157.32RVU15D
2015-07-01$293.61$157.32RVU15C
2015-04-01$292.15$156.53RVU15B
2015-01-01$292.15$156.53RVU15A
2014-10-01$287.72$156.08RVU14D
2014-07-01$287.72$156.08RVU14C
2014-04-01$287.72$156.08RVU14B
2014-01-01$287.72$156.08RVU14A
2013-10-01Contractor-pricedContractor-pricedRVU13D
2013-07-01Contractor-pricedContractor-pricedRVU13C
2013-04-01Contractor-pricedContractor-pricedRVU13B
2013-01-01Contractor-pricedContractor-pricedRVU13AR

Price 43252 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 43252PPRRVU2026_Oct_nonQPP.csv, line 5,181 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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