Billing code 43216: Esophageal lesion removalMedicare rate & RVUs
Flexible esophagoscopy removes an esophageal tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery during the procedure.
Medicare pays $454.59 for 43216 nationally in the office and $119.24 in a hospital or facility. Local office rates run $398.28–$623.41.
Medicare rate · 43216
Esophageal lesion removal
Swap in your local Medicare rate.
- Work RVUs
- 2.24
- Total RVUs
- 13.61
- Global days
- 000
National rate · 2026
$454.59
Office setting, before claim adjustments.
See every locality for 43216 → · 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.
On this page 10 sections
What 43216 covers
A gastroenterologist or other qualified endoscopist advances a flexible scope through the mouth to inspect the esophagus and remove a lesion with hot biopsy forceps or bipolar cautery. The service is used for therapeutic removal of an esophageal tumor, polyp, or other lesion, rather than inspection or tissue sampling alone. It is commonly performed in a facility-based endoscopy setting.
Report this code when the documented removal technique is hot biopsy forceps or bipolar cautery. The procedure note should identify the esophageal lesion and describe its removal and the technique used. 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. Modifier 50 is inappropriate for this service. CMS does not pay an assistant at surgery; 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.
Where 43216 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
$398.28 to $623.41
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $404.64 | $111.21 |
| Alaska* | $512.56 | $155.42 |
| Arizona | $441.91 | $116.96 |
| Arkansas | $398.28 | $110.22 |
| Atlanta | $462.37 | $121.66 |
| Austin | $475.38 | $120.59 |
| Bakersfield | $488.56 | $121.02 |
| Baltimore/Surr. Cntys | $484.82 | $125.00 |
| Beaumont | $420.56 | $115.40 |
| Brazoria | $450.08 | $117.75 |
| Chicago | $467.35 | $130.33 |
| Chico | $487.83 | $120.29 |
| Colorado | $477.52 | $120.71 |
| Connecticut | $486.39 | $125.22 |
| Dallas | $452.63 | $118.63 |
| Dc + Md/Va Suburbs | $525.70 | $130.67 |
| Delaware | $449.69 | $118.37 |
| Detroit | $447.07 | $123.47 |
| East St. Louis | $432.97 | $124.46 |
| El Centro | $487.87 | $120.33 |
| Fort Lauderdale | $465.90 | $126.19 |
| Fort Worth | $449.02 | $118.37 |
| Fresno | $487.83 | $120.29 |
| Galveston | $451.20 | $118.21 |
| Hanford-Corcoran | $487.83 | $120.29 |
| Hawaii, Guam | $502.14 | $120.85 |
| Houston | $455.60 | $122.60 |
| Idaho | $420.62 | $112.10 |
| Indiana | $423.33 | $112.46 |
| Iowa | $418.15 | $111.31 |
| Kansas | $414.92 | $111.77 |
| Kentucky | $412.64 | $114.52 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $522.99 | $126.28 |
| Madera | $487.83 | $120.29 |
| Manhattan | $524.30 | $134.62 |
| Merced | $487.83 | $120.29 |
| Metropolitan Boston | $528.89 | $128.49 |
| Metropolitan Kansas City | $431.73 | $116.84 |
| Metropolitan Philadelphia | $472.72 | $123.63 |
| Metropolitan St. Louis | $436.76 | $117.51 |
| Miami | $482.08 | $132.99 |
| Minnesota | $459.72 | $114.65 |
| Mississippi | $400.82 | $112.09 |
| Modesto | $487.83 | $120.29 |
| Montana** | $454.57 | $119.23 |
| Napa | $573.57 | $131.59 |
| Nebraska | $420.98 | $111.45 |
| Nevada** | $453.62 | $117.94 |
| New Hampshire | $468.83 | $119.73 |
| New Mexico | $425.34 | $117.83 |
| New Orleans | $433.74 | $118.18 |
| North Carolina | $426.79 | $113.91 |
| North Dakota** | $449.82 | $114.48 |
| Northern Nj | $519.33 | $130.32 |
| Nyc Suburbs/Long Island | $536.51 | $137.78 |
| Ohio | $422.31 | $116.14 |
| Oklahoma | $413.02 | $113.56 |
| Oxnard-Thousand Oaks-Ventura | $521.32 | $124.94 |
| Portland | $495.00 | $122.43 |
| Poughkpsie/N Nyc Suburbs | $494.95 | $127.75 |
| Puerto Rico | $458.56 | $119.52 |
| Queens | $530.58 | $134.20 |
| Redding | $487.83 | $120.29 |
| Rest Of California | $487.83 | $120.29 |
| Rest Of Florida | $442.26 | $121.67 |
| Rest Of Georgia | $415.98 | $116.85 |
| Rest Of Illinois | $426.76 | $120.59 |
| Rest Of Louisiana | $411.50 | $114.72 |
| Rest Of Maine | $421.82 | $113.30 |
| Rest Of Maryland | $459.14 | $119.77 |
| Rest Of Massachusetts | $473.86 | $120.74 |
| Rest Of Michigan | $423.28 | $117.11 |
| Rest Of Missouri | $403.08 | $114.01 |
| Rest Of New Jersey | $492.56 | $126.36 |
| Rest Of New York | $433.62 | $115.04 |
| Rest Of Oregon | $450.72 | $116.71 |
| Rest Of Pennsylvania | $423.66 | $115.81 |
| Rest Of Texas | $434.85 | $116.61 |
| Rest Of Washington | $473.35 | $120.23 |
| Rhode Island | $467.41 | $121.00 |
| Riverside-San Bernardino-Ontario | $490.44 | $122.90 |
| Sacramento-Roseville-Folsom | $514.16 | $124.15 |
| Salinas | $512.29 | $123.63 |
| San Diego-Chula Vista-Carlsbad | $526.02 | $124.95 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $609.78 | $136.94 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $609.50 | $136.67 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $623.41 | $139.84 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $622.30 | $138.73 |
| San Luis Obispo-Paso Robles | $503.81 | $121.85 |
| Santa Cruz-Watsonville | $532.36 | $124.92 |
| Santa Maria-Santa Barbara | $514.67 | $123.66 |
| Santa Rosa-Petaluma | $537.87 | $126.07 |
| Seattle (King Cnty) | $541.25 | $129.78 |
| South Carolina | $425.13 | $115.27 |
| South Dakota** | $449.26 | $113.92 |
| Southern Maine | $448.28 | $115.96 |
| Stockton | $487.83 | $120.29 |
| Suburban Chicago | $471.34 | $126.94 |
| Tennessee | $417.05 | $112.22 |
| Utah | $431.46 | $116.24 |
| Vallejo | $573.18 | $131.20 |
| Vermont | $446.91 | $114.92 |
| Virgin Islands | $458.56 | $119.52 |
| Virginia | $445.91 | $116.27 |
| Visalia | $487.83 | $120.29 |
| West Virginia | $409.34 | $117.93 |
| Wisconsin | $433.43 | $112.16 |
| Wyoming** | $452.50 | $117.16 |
| Yuba City | $487.83 | $120.29 |
43216 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.
$398.28
$555.62
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 | $512.56 | 1 |
| AL | $404.64 | 1 |
| AR | $398.28 | 1 |
| AZ | $441.91 | 1 |
| CA | $487.83–$623.41 | 29 |
| CO | $477.52 | 1 |
| CT | $486.39 | 1 |
| DC | $525.70 | 1 |
| DE | $449.69 | 1 |
| FL | $442.26–$482.08 | 3 |
| GA | $415.98–$462.37 | 2 |
| GU | $502.14 | 1 |
| HI | $502.14 | 1 |
| IA | $418.15 | 1 |
| ID | $420.62 | 1 |
| IL | $426.76–$471.34 | 4 |
| IN | $423.33 | 1 |
| KS | $414.92 | 1 |
| KY | $412.64 | 1 |
| LA | $411.50–$433.74 | 2 |
| MA | $473.86–$528.89 | 2 |
| MD | $459.14–$525.70 | 3 |
| ME | $421.82–$448.28 | 2 |
| MI | $423.28–$447.07 | 2 |
| MN | $459.72 | 1 |
| MO | $403.08–$436.76 | 3 |
| MS | $400.82 | 1 |
| MT | $454.57 | 1 |
| NC | $426.79 | 1 |
| ND | $449.82 | 1 |
| NE | $420.98 | 1 |
| NH | $468.83 | 1 |
| NJ | $492.56–$519.33 | 2 |
| NM | $425.34 | 1 |
| NV | $453.62 | 1 |
| NY | $433.62–$536.51 | 5 |
| OH | $422.31 | 1 |
| OK | $413.02 | 1 |
| OR | $450.72–$495.00 | 2 |
| PA | $423.66–$472.72 | 2 |
| PR | $458.56 | 1 |
| RI | $467.41 | 1 |
| SC | $425.13 | 1 |
| SD | $449.26 | 1 |
| TN | $417.05 | 1 |
| TX | $420.56–$475.38 | 8 |
| UT | $431.46 | 1 |
| VA | $445.91–$525.70 | 2 |
| VI | $458.56 | 1 |
| VT | $446.91 | 1 |
| WA | $473.35–$541.25 | 2 |
| WI | $433.43 | 1 |
| WV | $409.34 | 1 |
| WY | $452.50 | 1 |
How the 43216 rate is calculated
Each of 43216’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 · 43216
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.24Practice expense 11.13Malpractice 0.24
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43216
The CMS indicators that decide how 43216 is paid alongside other services.
CMS payment indicators · 43216
Esophageal lesion removal
| 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
43216 without 51 · national office
$454.59
Esophageal lesion removal
43216-51 · Second procedure: 50%
$227.30
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%).
43216 compared with similar codes
Compare codes
43216 vs 43217 vs 43211 vs 43229 vs 43202: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43217Esophageal lesion removal
- 43216 uses hot biopsy forceps or bipolar cautery to remove the lesion; 43217 is the snare-removal service.
- 43211Esophageal resection
- 43211 is for endoscopic mucosal resection of an esophageal lesion. This code is selected for removal with hot biopsy forceps or bipolar cautery.
- 43229Esophageal ablation
- 43229 is used for lesion ablation. This code describes lesion removal using hot biopsy forceps or bipolar cautery.
- 43202Esophageal biopsy
- 43202 is for biopsy during flexible esophagoscopy; this code is for therapeutic removal of an esophageal lesion.
43216 billing questions
How does this differ from 43217?
This code is for lesion removal with hot biopsy forceps or bipolar cautery. Use 43217 when a snare is used to remove the lesion.
When is 43211 a better choice?
43211 describes esophageal mucosal resection. Choose it when the documented therapeutic method is mucosal resection rather than removal with hot biopsy forceps or bipolar cautery.
Can a diagnostic biopsy be reported instead?
Use 43202 when the service is flexible esophagoscopy with biopsy rather than therapeutic lesion removal. The procedure documentation should support the service actually performed.
How does CMS price related endoscopies performed together?
CMS applies endoscopy-family pricing when related endoscopies are performed together. Payment is subject to that family pricing rather than treating every related endoscopy as an unrelated standalone service.
Which surgical modifiers or providers are permitted?
Modifier 50 is inappropriate. CMS does not pay an assistant at surgery for this service, and 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
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