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CMS RVU26D · Effective 2026-10-01

43250 in Redding

Office / nonfacility

$531.04

Base rate per service

Facility setting

$151.79

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Gastrointestinal endoscopy

About 43250: Upper endoscopy with cautery lesion removal

Reports upper endoscopic removal of a tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery.

During a transoral upper endoscopy, the physician examines the esophagus, stomach, and duodenum and removes a lesion using hot biopsy forceps or bipolar cautery. Gastroenterologists commonly perform this therapeutic procedure in an endoscopy unit or hospital, and it may also be performed in an appropriately equipped office. The defining feature is removal by the specified cautery technique, rather than snare excision or mucosal resection.

Select the code based on the documented removal method, not simply the presence of a lesion. The report should identify the treated site and lesion and describe 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 anatomy and descriptor. Medicare does not pay for an assistant at surgery, and co-surgeons and team surgery are not permitted.

CMS billing rules for 43250

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
Multiple procedures
Endoscopy family pricing applies when related endoscopies are performed together.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU2.90 · 19%
  • Practice expense (office) RVU11.61 · 78%
  • Malpractice RVU0.42 · 3%

3.5K

Medicare services in 2024 · #2072 by national volume

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.

43250 compared with similar codes

Office rates for Redding, from the same CMS release.

43251

EGD lesion removal

Snare technique

$581.95

Choose 43250 for removal with hot biopsy forceps or bipolar cautery; choose 43251 when a snare is used.

43254

Endoscopic resection

Mucosal resection

No office rate

43254 identifies endoscopic mucosal resection. This code is for lesion removal with hot biopsy forceps or bipolar cautery.

43239

EGD with biopsy

Single or multiple biopsies

$447.86

43239 is for upper endoscopic biopsy. Use this code when the documented service removes the lesion with the specified cautery technique.

The same code, a different location

How does Redding compare?

In Bakersfield, the office rate for 43250 is $532.26—$1.22 higher than the $531.04 rate in Redding. Both use the same code, release and participation basis.

43250 across payment areas

Same release and payment basis · bars start at $0

  1. Redding · This locality

    $531.04

  2. Bakersfield

    $532.26

    $1.22 higher than Redding

  3. Chico

    $531.04

    The same base rate than Redding

  4. El Centro

    $531.11

    $0.07 higher than Redding

  5. Fresno

    $531.04

    The same base rate than Redding

  6. Hanford-Corcoran

    $531.04

    The same base rate than Redding

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $568.90

    $37.86 higher than Redding

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 43250 ranges from $437.19 in Arkansas to $674.22 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 43250

    Office

    $531.04

    Facility

    $151.79

    The same base rate than Redding for the office setting.

  • Merced

    California · 43250

    Office

    $531.04

    Facility

    $151.79

    The same base rate than Redding for the office setting.

  • Modesto

    California · 43250

    Office

    $531.04

    Facility

    $151.79

    The same base rate than Redding for the office setting.

  • Napa

    California · 43250

    Office

    $621.19

    Facility

    $165.12

    $90.15 higher than Redding for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 43250

    Office

    $566.68

    Facility

    $157.66

    $35.64 higher than Redding for the office setting.

  • Rest Of California

    California · 43250

    Office

    $531.04

    Facility

    $151.79

    The same base rate than Redding for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 43250

    Office

    $535.58

    Facility

    $156.33

    $4.54 higher than Redding for the office setting.

  • Sacramento-Roseville-Folsom

    California · 43250

    Office

    $558.86

    Facility

    $156.43

    $27.82 higher than Redding for the office setting.

  • Salinas

    California · 43250

    Office

    $556.83

    Facility

    $155.77

    $25.79 higher than Redding for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 43250

    Office

    $571.16

    Facility

    $157.31

    $40.12 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 43250

    Office

    $659.28

    Facility

    $171.37

    $128.24 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 43250

    Office

    $658.80

    Facility

    $170.90

    $127.76 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 43250

    Office

    $674.22

    Facility

    $175.24

    $143.18 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 43250

    Office

    $672.27

    Facility

    $173.29

    $141.23 higher than Redding for the office setting.

  • San Luis Obispo-Paso Robles

    California · 43250

    Office

    $547.71

    Facility

    $153.58

    $16.67 higher than Redding for the office setting.

  • Santa Cruz-Watsonville

    California · 43250

    Office

    $577.57

    Facility

    $157.14

    $46.53 higher than Redding for the office setting.

  • Santa Maria-Santa Barbara

    California · 43250

    Office

    $559.25

    Facility

    $155.78

    $28.21 higher than Redding for the office setting.

  • Santa Rosa-Petaluma

    California · 43250

    Office

    $583.49

    Facility

    $158.56

    $52.45 higher than Redding for the office setting.

  • Stockton

    California · 43250

    Office

    $531.04

    Facility

    $151.79

    The same base rate than Redding for the office setting.

  • Vallejo

    California · 43250

    Office

    $620.50

    Facility

    $164.43

    $89.46 higher than Redding for the office setting.

  • Visalia

    California · 43250

    Office

    $531.04

    Facility

    $151.79

    The same base rate than Redding for the office setting.

  • Yuba City

    California · 43250

    Office

    $531.04

    Facility

    $151.79

    The same base rate than Redding for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 43250

    Office

    $574.52

    Facility

    $166.89

    $43.48 higher than Redding for the office setting.

  • Miami

    Florida · 43250

    Office

    $536.02

    Facility

    $175.80

    $4.98 higher than Redding for the office setting.

  • Chicago

    Illinois · 43250

    Office

    $519.46

    Facility

    $171.70

    $11.58 lower than Redding for the office setting.

  • Manhattan

    New York · 43250

    Office

    $575.92

    Facility

    $173.83

    $44.88 higher than Redding for the office setting.

  • Alaska*

    Alaska · 43250

    Office

    $566.01

    Facility

    $197.49

    $34.97 higher than Redding for the office setting.

  • Alabama

    Alabama · 43250

    Office

    $444.11

    Facility

    $141.33

    $86.93 lower than Redding for the office setting.

  • Arkansas

    Arkansas · 43250

    Office

    $437.19

    Facility

    $139.95

    $93.85 lower than Redding for the office setting.

  • Arizona

    Arizona · 43250

    Office

    $484.63

    Facility

    $149.33

    $46.41 lower than Redding for the office setting.

  • Colorado

    Colorado · 43250

    Office

    $521.58

    Facility

    $153.40

    $9.46 lower than Redding for the office setting.

  • Connecticut

    Connecticut · 43250

    Office

    $533.42

    Facility

    $160.74

    $2.38 higher than Redding for the office setting.

  • Delaware

    Delaware · 43250

    Office

    $493.09

    Facility

    $151.21

    $37.95 lower than Redding for the office setting.

  • Fort Lauderdale

    Florida · 43250

    Office

    $515.05

    Facility

    $164.52

    $15.99 lower than Redding for the office setting.

  • Rest Of Florida

    Florida · 43250

    Office

    $488.67

    Facility

    $157.86

    $42.37 lower than Redding for the office setting.

  • Atlanta

    Georgia · 43250

    Office

    $507.99

    Facility

    $156.42

    $23.05 lower than Redding for the office setting.

  • Rest Of Georgia

    Georgia · 43250

    Office

    $459.49

    Facility

    $150.83

    $71.55 lower than Redding for the office setting.

  • Hawaii, Guam

    Hawaii · 43250

    Office

    $545.90

    Facility

    $152.46

    $14.86 higher than Redding for the office setting.

  • Iowa

    Iowa · 43250

    Office

    $457.25

    Facility

    $140.63

    $73.79 lower than Redding for the office setting.

  • Idaho

    Idaho · 43250

    Office

    $460.26

    Facility

    $141.91

    $70.78 lower than Redding for the office setting.

  • East St. Louis

    Illinois · 43250

    Office

    $481.88

    Facility

    $163.53

    $49.16 lower than Redding for the office setting.

  • Rest Of Illinois

    Illinois · 43250

    Office

    $472.84

    Facility

    $156.91

    $58.20 lower than Redding for the office setting.

  • Suburban Chicago

    Illinois · 43250

    Office

    $520.65

    Facility

    $165.28

    $10.39 lower than Redding for the office setting.

  • Indiana

    Indiana · 43250

    Office

    $463.16

    Facility

    $142.38

    $67.88 lower than Redding for the office setting.

  • Kansas

    Kansas · 43250

    Office

    $454.49

    Facility

    $141.68

    $76.55 lower than Redding for the office setting.

  • Kentucky

    Kentucky · 43250

    Office

    $454.44

    Facility

    $146.82

    $76.60 lower than Redding for the office setting.

  • New Orleans

    Louisiana · 43250

    Office

    $477.70

    Facility

    $152.09

    $53.34 lower than Redding for the office setting.

  • Rest Of Louisiana

    Louisiana · 43250

    Office

    $453.49

    Facility

    $147.25

    $77.55 lower than Redding for the office setting.

  • Metropolitan Boston

    Massachusetts · 43250

    Office

    $576.33

    Facility

    $163.17

    $45.29 higher than Redding for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 43250

    Office

    $517.93

    Facility

    $153.56

    $13.11 lower than Redding for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 43250

    Office

    $531.86

    Facility

    $160.56

    $0.82 higher than Redding for the office setting.

  • Rest Of Maryland

    Maryland · 43250

    Office

    $503.15

    Facility

    $152.96

    $27.89 lower than Redding for the office setting.

  • Rest Of Maine

    Maine · 43250

    Office

    $462.35

    Facility

    $144.00

    $68.69 lower than Redding for the office setting.

  • Southern Maine

    Maine · 43250

    Office

    $490.01

    Facility

    $147.09

    $41.03 lower than Redding for the office setting.

  • Detroit

    Michigan · 43250

    Office

    $494.73

    Facility

    $160.80

    $36.31 lower than Redding for the office setting.

  • Rest Of Michigan

    Michigan · 43250

    Office

    $466.75

    Facility

    $150.82

    $64.29 lower than Redding for the office setting.

  • Minnesota

    Minnesota · 43250

    Office

    $500.05

    Facility

    $143.98

    $30.99 lower than Redding for the office setting.

  • Metropolitan Kansas City

    Missouri · 43250

    Office

    $474.70

    Facility

    $149.77

    $56.34 lower than Redding for the office setting.

  • Metropolitan St. Louis

    Missouri · 43250

    Office

    $480.09

    Facility

    $150.67

    $50.95 lower than Redding for the office setting.

  • Rest Of Missouri

    Missouri · 43250

    Office

    $444.80

    Facility

    $146.52

    $86.24 lower than Redding for the office setting.

  • Mississippi

    Mississippi · 43250

    Office

    $441.11

    Facility

    $143.18

    $89.93 lower than Redding for the office setting.

  • Montana**

    Montana · 43250

    Office

    $498.65

    Facility

    $152.61

    $32.39 lower than Redding for the office setting.

  • North Carolina

    North Carolina · 43250

    Office

    $467.63

    Facility

    $144.78

    $63.41 lower than Redding for the office setting.

  • North Dakota**

    North Dakota · 43250

    Office

    $490.34

    Facility

    $144.31

    $40.70 lower than Redding for the office setting.

  • Nebraska

    Nebraska · 43250

    Office

    $460.09

    Facility

    $140.70

    $70.95 lower than Redding for the office setting.

  • New Hampshire

    New Hampshire · 43250

    Office

    $512.82

    Facility

    $152.60

    $18.22 lower than Redding for the office setting.

  • Northern Nj

    New Jersey · 43250

    Office

    $567.78

    Facility

    $166.38

    $36.74 higher than Redding for the office setting.

  • Rest Of New Jersey

    New Jersey · 43250

    Office

    $539.59

    Facility

    $161.72

    $8.55 higher than Redding for the office setting.

  • New Mexico

    New Mexico · 43250

    Office

    $469.31

    Facility

    $152.00

    $61.73 lower than Redding for the office setting.

  • Nevada**

    Nevada · 43250

    Office

    $496.72

    Facility

    $150.34

    $34.32 lower than Redding for the office setting.

  • Nyc Suburbs/Long Island

    New York · 43250

    Office

    $590.19

    Facility

    $178.75

    $59.15 higher than Redding for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 43250

    Office

    $542.82

    Facility

    $163.91

    $11.78 higher than Redding for the office setting.

  • Queens

    New York · 43250

    Office

    $581.65

    Facility

    $172.64

    $50.61 higher than Redding for the office setting.

  • Rest Of New York

    New York · 43250

    Office

    $475.12

    Facility

    $146.39

    $55.92 lower than Redding for the office setting.

  • Ohio

    Ohio · 43250

    Office

    $465.05

    Facility

    $149.12

    $65.99 lower than Redding for the office setting.

  • Oklahoma

    Oklahoma · 43250

    Office

    $454.05

    Facility

    $145.05

    $76.99 lower than Redding for the office setting.

  • Portland

    Oregon · 43250

    Office

    $539.68

    Facility

    $155.24

    $8.64 higher than Redding for the office setting.

  • Rest Of Oregon

    Oregon · 43250

    Office

    $492.96

    Facility

    $148.31

    $38.08 lower than Redding for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 43250

    Office

    $519.03

    Facility

    $158.80

    $12.01 lower than Redding for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 43250

    Office

    $466.11

    Facility

    $148.45

    $64.93 lower than Redding for the office setting.

  • Puerto Rico

    Puerto Rico · 43250

    Office

    $502.73

    Facility

    $152.89

    $28.31 lower than Redding for the office setting.

  • Rhode Island

    Rhode Island · 43250

    Office

    $511.80

    Facility

    $154.35

    $19.24 lower than Redding for the office setting.

  • South Carolina

    South Carolina · 43250

    Office

    $467.10

    Facility

    $147.36

    $63.94 lower than Redding for the office setting.

  • South Dakota**

    South Dakota · 43250

    Office

    $489.36

    Facility

    $143.33

    $41.68 lower than Redding for the office setting.

  • Tennessee

    Tennessee · 43250

    Office

    $456.89

    Facility

    $142.35

    $74.15 lower than Redding for the office setting.

  • Austin

    Texas · 43250

    Office

    $519.76

    Facility

    $153.66

    $11.28 lower than Redding for the office setting.

  • Beaumont

    Texas · 43250

    Office

    $462.78

    Facility

    $147.89

    $68.26 lower than Redding for the office setting.

  • Brazoria

    Texas · 43250

    Office

    $492.87

    Facility

    $149.96

    $38.17 lower than Redding for the office setting.

  • Dallas

    Texas · 43250

    Office

    $496.00

    Facility

    $151.35

    $35.04 lower than Redding for the office setting.

  • Fort Worth

    Texas · 43250

    Office

    $492.31

    Facility

    $151.12

    $38.73 lower than Redding for the office setting.

  • Galveston

    Texas · 43250

    Office

    $494.32

    Facility

    $150.71

    $36.72 lower than Redding for the office setting.

  • Houston

    Texas · 43250

    Office

    $502.01

    Facility

    $158.40

    $29.03 lower than Redding for the office setting.

  • Rest Of Texas

    Texas · 43250

    Office

    $477.54

    Facility

    $149.15

    $53.50 lower than Redding for the office setting.

  • Utah

    Utah · 43250

    Office

    $473.98

    Facility

    $148.71

    $57.06 lower than Redding for the office setting.

  • Virginia

    Virginia · 43250

    Office

    $487.96

    Facility

    $147.81

    $43.08 lower than Redding for the office setting.

  • Virgin Islands

    United States Virgin Islands · 43250

    Office

    $502.73

    Facility

    $152.89

    $28.31 lower than Redding for the office setting.

  • Vermont

    Vermont · 43250

    Office

    $487.87

    Facility

    $145.29

    $43.17 lower than Redding for the office setting.

  • Rest Of Washington

    Washington · 43250

    Office

    $517.13

    Facility

    $152.76

    $13.91 lower than Redding for the office setting.

  • Seattle (King Cnty)

    Washington · 43250

    Office

    $588.98

    Facility

    $164.40

    $57.94 higher than Redding for the office setting.

  • Wisconsin

    Wisconsin · 43250

    Office

    $472.68

    Facility

    $141.18

    $58.36 lower than Redding for the office setting.

  • West Virginia

    West Virginia · 43250

    Office

    $453.92

    Facility

    $153.22

    $77.12 lower than Redding for the office setting.

  • Wyoming**

    Wyoming · 43250

    Office

    $495.03

    Facility

    $148.99

    $36.01 lower than Redding for the office setting.

See how rates vary across the country

43250 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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.

$437.19

$602.63

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$566.011
AL$444.111
AR$437.191
AZ$484.631
CA$531.04–$674.2229
CO$521.581
CT$533.421
DC$574.521
DE$493.091
FL$488.67–$536.023
GA$459.49–$507.992
GU$545.901
HI$545.901
IA$457.251
ID$460.261
IL$472.84–$520.654
IN$463.161
KS$454.491
KY$454.441
LA$453.49–$477.702
MA$517.93–$576.332
MD$503.15–$574.523
ME$462.35–$490.012
MI$466.75–$494.732
MN$500.051
MO$444.80–$480.093
MS$441.111
MT$498.651
NC$467.631
ND$490.341
NE$460.091
NH$512.821
NJ$539.59–$567.782
NM$469.311
NV$496.721
NY$475.12–$590.195
OH$465.051
OK$454.051
OR$492.96–$539.682
PA$466.11–$519.032
PR$502.731
RI$511.801
SC$467.101
SD$489.361
TN$456.891
TX$462.78–$519.768
UT$473.981
VA$487.96–$574.522
VI$502.731
VT$487.871
WA$517.13–$588.982
WI$472.681
WV$453.921
WY$495.031

Explore 43250 on the national rate map →

Where does this rate apply?

Redding is a Medicare payment area. Our Census mapping connects it to 32 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 43250 in Redding, the physician’s office rate is $531.04 and the facility-setting rate is $151.79: a difference of $379.25.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 43250 in Redding. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$584.14

$531.04 × 110% = $584.14

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43250 in Redding.

PPRRVU2026_Oct_nonQPP.csv

5,179

Code
43250
Physician work
2.90
Practice expense
11.61
Malpractice
0.42

GPCI2026.csv

19

Locality
Redding
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 43250 in Redding
ComponentRVULocality factorAdjusted
Physician work2.90× 1.0172.9493
Practice expense11.61× 1.09612.7246
Malpractice0.42× 0.5360.2251
Total RVUs15.8990
Conversion factor× 33.4009

Office / nonfacility rate, Redding$531.04

Open 43250 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work2.91.017
Practice expense11.611.096
Malpractice0.420.536

(2.9 × 1.017 + 11.61 × 1.096 + 0.42 × 0.536) × $33.4009 = $531.04

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work2.91.017
Practice expense1.251.096
Malpractice0.420.536

(2.9 × 1.017 + 1.25 × 1.096 + 0.42 × 0.536) × $33.4009 = $151.79

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

43250 · Office / nonfacility

$531.04

Effective 2026-10-01

The base rate is $79.53 higher than on 2025-10-01, moving from $451.51 to $531.04 (17.6%).

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

    $451.51changed to$531.04

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.97 changed to 2.90
    • Practice expense RVU 9.79 changed to 11.61
    • Malpractice RVU 0.44 changed to 0.42
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $451.51

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$531.04$151.79RVU26D
2026-07-01$531.04$151.79RVU26C
2026-04-01$531.04$151.79RVU26B
2026-01-01$531.04$151.79RVU26A
2025-10-01$451.51$163.72RVU25D
2025-07-01$451.51$163.72RVU25C
2025-04-01$451.51$163.72RVU25B
2025-01-01$451.51$163.72RVU25A

43250 billing questions

How does this differ from 43251?

This code is for lesion removal with hot biopsy forceps or bipolar cautery. Code 43251 describes removal by snare, so the documented technique distinguishes them.

When is 43254 a better choice?

Use 43254 when the physician performs endoscopic mucosal resection. This code instead identifies removal using hot biopsy forceps or bipolar cautery.

Should units be based on the number of lesions?

Document each treated lesion and the technique, but do not assume that each lesion supports a separate unit. The service is an upper endoscopic removal procedure.

What documentation supports this code?

The procedure report should identify the lesion and its location and state that removal was performed with hot biopsy forceps or bipolar cautery.

Can a modifier 50 be used for lesions on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this descriptor and anatomy.

How are related endoscopies handled when performed together?

CMS endoscopy family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included in this code's 0-day global period.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 43250PPRRVU2026_Oct_nonQPP.csv, line 5,179 (RVU26D)
Geographic factors for ReddingGPCI2026.csv, line 19 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet