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CMS RVU26D · Effective 2026-10-01

43251 in Wyoming**

Office / nonfacility

$542.38

Base rate per service

Facility setting

$169.63

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.

Gastroenterology

About 43251: Upper endoscopy snare lesion removal

Reports upper endoscopy with snare removal of a polyp or other lesion in the esophagus, stomach, or duodenum.

A gastroenterologist or other qualified endoscopist uses a flexible upper endoscope and a snare to remove a polyp or other lesion from the esophagus, stomach, or duodenum. The service is commonly performed in a hospital outpatient department or an ambulatory endoscopy center, with the removed tissue typically sent for pathology. The defining feature is removal by snare, rather than sampling alone or removal by a different method.

Report the service for the snare removal performed during the EGD, not once for each lesion removed in the same session. The procedure report should identify the lesion site and describe its removal technique and the findings. 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. The assistant-at-surgery statutory restriction means Medicare does not pay an assistant for this procedure; co-surgeons and team surgery are not permitted.

CMS billing rules for 43251

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 RVU3.38 · 21%
  • Practice expense (office) RVU12.57 · 77%
  • Malpractice RVU0.39 · 2%

64.4K

Medicare services in 2024 · #694 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.

43251 compared with similar codes

Office rates for Wyoming**, from the same CMS release.

43250

Upper endoscopy

Cautery lesion removal

$495.03

Choose 43251 for snare removal. Choose 43250 when the lesion is removed with hot biopsy forceps or bipolar cautery.

43254

Endoscopic resection

Mucosal resection

No office rate

43254 describes endoscopic mucosal resection. Use 43251 when the documented removal is by snare and is not an EMR.

43239

EGD with biopsy

Single or multiple biopsies

$416.50

43239 is for biopsy sampling. This code is for removing a lesion with a snare, not merely taking tissue samples.

The same code, a different location

How does Wyoming** compare?

43251 across payment areas

Same release and payment basis · bars start at $0

  1. Wyoming** · This locality

    $542.38

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

    $622.85

    $80.47 higher than Wyoming**

  3. Dc + Md/Va Suburbs

    $628.07

    $85.69 higher than Wyoming**

  4. Miami

    $582.90

    $40.52 higher than Wyoming**

  5. Chicago

    $565.53

    $23.15 higher than Wyoming**

  6. Manhattan

    $628.65

    $86.27 higher than Wyoming**

  7. Alaska*

    $623.66

    $81.28 higher than Wyoming**

Other payment areas listed in Wyoming 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, 43251 ranges from $480.25 in Arkansas to $737.72 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

  • Alabama

    Alabama · 43251

    Office

    $487.64

    Facility

    $161.48

    $54.74 lower than Wyoming** for the office setting.

  • Arkansas

    Arkansas · 43251

    Office

    $480.25

    Facility

    $160.06

    $62.13 lower than Wyoming** for the office setting.

  • Arizona

    Arizona · 43251

    Office

    $530.88

    Facility

    $169.68

    $11.50 lower than Wyoming** for the office setting.

  • Bakersfield

    California · 43251

    Office

    $583.13

    Facility

    $174.59

    $40.75 higher than Wyoming** for the office setting.

  • Chico

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • El Centro

    California · 43251

    Office

    $582.02

    Facility

    $173.48

    $39.64 higher than Wyoming** for the office setting.

  • Fresno

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Hanford-Corcoran

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Madera

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Merced

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Modesto

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Napa

    California · 43251

    Office

    $679.99

    Facility

    $188.70

    $137.61 higher than Wyoming** for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 43251

    Office

    $620.43

    Facility

    $179.84

    $78.05 higher than Wyoming** for the office setting.

  • Redding

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Rest Of California

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 43251

    Office

    $586.19

    Facility

    $177.66

    $43.81 higher than Wyoming** for the office setting.

  • Sacramento-Roseville-Folsom

    California · 43251

    Office

    $612.23

    Facility

    $178.71

    $69.85 higher than Wyoming** for the office setting.

  • Salinas

    California · 43251

    Office

    $609.98

    Facility

    $177.96

    $67.60 higher than Wyoming** for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 43251

    Office

    $625.48

    Facility

    $179.67

    $83.10 higher than Wyoming** for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 43251

    Office

    $721.59

    Facility

    $196.00

    $179.21 higher than Wyoming** for the office setting.

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

    California · 43251

    Office

    $721.14

    Facility

    $195.56

    $178.76 higher than Wyoming** for the office setting.

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

    California · 43251

    Office

    $737.72

    Facility

    $200.21

    $195.34 higher than Wyoming** for the office setting.

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

    California · 43251

    Office

    $735.91

    Facility

    $198.40

    $193.53 higher than Wyoming** for the office setting.

  • San Luis Obispo-Paso Robles

    California · 43251

    Office

    $600.00

    Facility

    $175.44

    $57.62 higher than Wyoming** for the office setting.

  • Santa Cruz-Watsonville

    California · 43251

    Office

    $632.36

    Facility

    $179.47

    $89.98 higher than Wyoming** for the office setting.

  • Santa Maria-Santa Barbara

    California · 43251

    Office

    $612.58

    Facility

    $177.95

    $70.20 higher than Wyoming** for the office setting.

  • Santa Rosa-Petaluma

    California · 43251

    Office

    $638.84

    Facility

    $181.10

    $96.46 higher than Wyoming** for the office setting.

  • Stockton

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Vallejo

    California · 43251

    Office

    $679.35

    Facility

    $188.06

    $136.97 higher than Wyoming** for the office setting.

  • Visalia

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Yuba City

    California · 43251

    Office

    $581.95

    Facility

    $173.41

    $39.57 higher than Wyoming** for the office setting.

  • Colorado

    Colorado · 43251

    Office

    $571.14

    Facility

    $174.53

    $28.76 higher than Wyoming** for the office setting.

  • Connecticut

    Connecticut · 43251

    Office

    $583.09

    Facility

    $181.64

    $40.71 higher than Wyoming** for the office setting.

  • Delaware

    Delaware · 43251

    Office

    $539.98

    Facility

    $171.70

    $2.40 lower than Wyoming** for the office setting.

  • Fort Lauderdale

    Florida · 43251

    Office

    $561.75

    Facility

    $184.15

    $19.37 higher than Wyoming** for the office setting.

  • Rest Of Florida

    Florida · 43251

    Office

    $533.85

    Facility

    $177.50

    $8.53 lower than Wyoming** for the office setting.

  • Atlanta

    Georgia · 43251

    Office

    $555.45

    Facility

    $176.73

    $13.07 higher than Wyoming** for the office setting.

  • Rest Of Georgia

    Georgia · 43251

    Office

    $502.93

    Facility

    $170.43

    $39.45 lower than Wyoming** for the office setting.

  • Hawaii, Guam

    Hawaii · 43251

    Office

    $597.81

    Facility

    $173.98

    $55.43 higher than Wyoming** for the office setting.

  • Iowa

    Iowa · 43251

    Office

    $502.23

    Facility

    $161.16

    $40.15 lower than Wyoming** for the office setting.

  • Idaho

    Idaho · 43251

    Office

    $505.32

    Facility

    $162.38

    $37.06 lower than Wyoming** for the office setting.

  • East St. Louis

    Illinois · 43251

    Office

    $525.39

    Facility

    $182.46

    $16.99 lower than Wyoming** for the office setting.

  • Rest Of Illinois

    Illinois · 43251

    Office

    $516.58

    Facility

    $176.25

    $25.80 lower than Wyoming** for the office setting.

  • Suburban Chicago

    Illinois · 43251

    Office

    $567.95

    Facility

    $185.13

    $25.57 higher than Wyoming** for the office setting.

  • Indiana

    Indiana · 43251

    Office

    $508.43

    Facility

    $162.88

    $33.95 lower than Wyoming** for the office setting.

  • Kansas

    Kansas · 43251

    Office

    $499.00

    Facility

    $162.03

    $43.38 lower than Wyoming** for the office setting.

  • Kentucky

    Kentucky · 43251

    Office

    $498.06

    Facility

    $166.68

    $44.32 lower than Wyoming** for the office setting.

  • New Orleans

    Louisiana · 43251

    Office

    $522.77

    Facility

    $172.01

    $19.61 lower than Wyoming** for the office setting.

  • Rest Of Louisiana

    Louisiana · 43251

    Office

    $496.94

    Facility

    $167.05

    $45.44 lower than Wyoming** for the office setting.

  • Metropolitan Boston

    Massachusetts · 43251

    Office

    $630.42

    Facility

    $185.35

    $88.04 higher than Wyoming** for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 43251

    Office

    $567.18

    Facility

    $174.67

    $24.80 higher than Wyoming** for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 43251

    Office

    $581.31

    Facility

    $181.35

    $38.93 higher than Wyoming** for the office setting.

  • Rest Of Maryland

    Maryland · 43251

    Office

    $550.87

    Facility

    $173.64

    $8.49 higher than Wyoming** for the office setting.

  • Rest Of Maine

    Maine · 43251

    Office

    $507.26

    Facility

    $164.33

    $35.12 lower than Wyoming** for the office setting.

  • Southern Maine

    Maine · 43251

    Office

    $537.19

    Facility

    $167.79

    $5.19 lower than Wyoming** for the office setting.

  • Detroit

    Michigan · 43251

    Office

    $540.01

    Facility

    $180.30

    $2.37 lower than Wyoming** for the office setting.

  • Rest Of Michigan

    Michigan · 43251

    Office

    $510.92

    Facility

    $170.60

    $31.46 lower than Wyoming** for the office setting.

  • Minnesota

    Minnesota · 43251

    Office

    $548.78

    Facility

    $165.21

    $6.40 higher than Wyoming** for the office setting.

  • Metropolitan Kansas City

    Missouri · 43251

    Office

    $519.86

    Facility

    $169.84

    $22.52 lower than Wyoming** for the office setting.

  • Metropolitan St. Louis

    Missouri · 43251

    Office

    $525.64

    Facility

    $170.78

    $16.74 lower than Wyoming** for the office setting.

  • Rest Of Missouri

    Missouri · 43251

    Office

    $487.49

    Facility

    $166.18

    $54.89 lower than Wyoming** for the office setting.

  • Mississippi

    Mississippi · 43251

    Office

    $484.01

    Facility

    $163.07

    $58.37 lower than Wyoming** for the office setting.

  • Montana**

    Montana · 43251

    Office

    $545.74

    Facility

    $172.99

    $3.36 higher than Wyoming** for the office setting.

  • North Carolina

    North Carolina · 43251

    Office

    $512.94

    Facility

    $165.16

    $29.44 lower than Wyoming** for the office setting.

  • North Dakota**

    North Dakota · 43251

    Office

    $538.03

    Facility

    $165.28

    $4.35 lower than Wyoming** for the office setting.

  • Nebraska

    Nebraska · 43251

    Office

    $505.34

    Facility

    $161.29

    $37.04 lower than Wyoming** for the office setting.

  • New Hampshire

    New Hampshire · 43251

    Office

    $561.36

    Facility

    $173.32

    $18.98 higher than Wyoming** for the office setting.

  • Northern Nj

    New Jersey · 43251

    Office

    $620.94

    Facility

    $188.55

    $78.56 higher than Wyoming** for the office setting.

  • Rest Of New Jersey

    New Jersey · 43251

    Office

    $590.18

    Facility

    $183.13

    $47.80 higher than Wyoming** for the office setting.

  • New Mexico

    New Mexico · 43251

    Office

    $513.54

    Facility

    $171.73

    $28.84 lower than Wyoming** for the office setting.

  • Nevada**

    Nevada · 43251

    Office

    $544.02

    Facility

    $170.89

    $1.64 higher than Wyoming** for the office setting.

  • Nyc Suburbs/Long Island

    New York · 43251

    Office

    $643.51

    Facility

    $200.31

    $101.13 higher than Wyoming** for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 43251

    Office

    $593.47

    Facility

    $185.31

    $51.09 higher than Wyoming** for the office setting.

  • Queens

    New York · 43251

    Office

    $635.17

    Facility

    $194.57

    $92.79 higher than Wyoming** for the office setting.

  • Rest Of New York

    New York · 43251

    Office

    $520.91

    Facility

    $166.79

    $21.47 lower than Wyoming** for the office setting.

  • Ohio

    Ohio · 43251

    Office

    $509.35

    Facility

    $169.02

    $33.03 lower than Wyoming** for the office setting.

  • Oklahoma

    Oklahoma · 43251

    Office

    $497.94

    Facility

    $165.07

    $44.44 lower than Wyoming** for the office setting.

  • Portland

    Oregon · 43251

    Office

    $590.85

    Facility

    $176.72

    $48.47 higher than Wyoming** for the office setting.

  • Rest Of Oregon

    Oregon · 43251

    Office

    $540.22

    Facility

    $168.96

    $2.16 lower than Wyoming** for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 43251

    Office

    $567.53

    Facility

    $179.49

    $25.15 higher than Wyoming** for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 43251

    Office

    $510.63

    Facility

    $168.44

    $31.75 lower than Wyoming** for the office setting.

  • Puerto Rico

    Puerto Rico · 43251

    Office

    $550.19

    Facility

    $173.34

    $7.81 higher than Wyoming** for the office setting.

  • Rhode Island

    Rhode Island · 43251

    Office

    $560.36

    Facility

    $175.31

    $17.98 higher than Wyoming** for the office setting.

  • South Carolina

    South Carolina · 43251

    Office

    $511.91

    Facility

    $167.48

    $30.47 lower than Wyoming** for the office setting.

  • South Dakota**

    South Dakota · 43251

    Office

    $537.12

    Facility

    $164.37

    $5.26 lower than Wyoming** for the office setting.

  • Tennessee

    Tennessee · 43251

    Office

    $501.53

    Facility

    $162.70

    $40.85 lower than Wyoming** for the office setting.

  • Austin

    Texas · 43251

    Office

    $568.86

    Facility

    $174.49

    $26.48 higher than Wyoming** for the office setting.

  • Beaumont

    Texas · 43251

    Office

    $507.06

    Facility

    $167.85

    $35.32 lower than Wyoming** for the office setting.

  • Brazoria

    Texas · 43251

    Office

    $540.03

    Facility

    $170.63

    $2.35 lower than Wyoming** for the office setting.

  • Dallas

    Texas · 43251

    Office

    $543.26

    Facility

    $171.99

    $0.88 higher than Wyoming** for the office setting.

  • Fort Worth

    Texas · 43251

    Office

    $539.23

    Facility

    $171.69

    $3.15 lower than Wyoming** for the office setting.

  • Galveston

    Texas · 43251

    Office

    $541.49

    Facility

    $171.35

    $0.89 lower than Wyoming** for the office setting.

  • Houston

    Texas · 43251

    Office

    $548.63

    Facility

    $178.49

    $6.25 higher than Wyoming** for the office setting.

  • Rest Of Texas

    Texas · 43251

    Office

    $523.09

    Facility

    $169.35

    $19.29 lower than Wyoming** for the office setting.

  • Utah

    Utah · 43251

    Office

    $519.25

    Facility

    $168.86

    $23.13 lower than Wyoming** for the office setting.

  • Virginia

    Virginia · 43251

    Office

    $534.80

    Facility

    $168.39

    $7.58 lower than Wyoming** for the office setting.

  • Virgin Islands

    United States Virgin Islands · 43251

    Office

    $550.19

    Facility

    $173.34

    $7.81 higher than Wyoming** for the office setting.

  • Vermont

    Vermont · 43251

    Office

    $535.14

    Facility

    $166.11

    $7.24 lower than Wyoming** for the office setting.

  • Rest Of Washington

    Washington · 43251

    Office

    $566.38

    Facility

    $173.87

    $24.00 higher than Wyoming** for the office setting.

  • Seattle (King Cnty)

    Washington · 43251

    Office

    $644.34

    Facility

    $186.97

    $101.96 higher than Wyoming** for the office setting.

  • Wisconsin

    Wisconsin · 43251

    Office

    $519.12

    Facility

    $162.02

    $23.26 lower than Wyoming** for the office setting.

  • West Virginia

    West Virginia · 43251

    Office

    $496.38

    Facility

    $172.46

    $46.00 lower than Wyoming** for the office setting.

See how rates vary across the country

43251 · 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.

$480.25

$659.84

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$623.661
AL$487.641
AR$480.251
AZ$530.881
CA$581.95–$737.7229
CO$571.141
CT$583.091
DC$628.071
DE$539.981
FL$533.85–$582.903
GA$502.93–$555.452
GU$597.811
HI$597.811
IA$502.231
ID$505.321
IL$516.58–$567.954
IN$508.431
KS$499.001
KY$498.061
LA$496.94–$522.772
MA$567.18–$630.422
MD$550.87–$628.073
ME$507.26–$537.192
MI$510.92–$540.012
MN$548.781
MO$487.49–$525.643
MS$484.011
MT$545.741
NC$512.941
ND$538.031
NE$505.341
NH$561.361
NJ$590.18–$620.942
NM$513.541
NV$544.021
NY$520.91–$643.515
OH$509.351
OK$497.941
OR$540.22–$590.852
PA$510.63–$567.532
PR$550.191
RI$560.361
SC$511.911
SD$537.121
TN$501.531
TX$507.06–$568.868
UT$519.251
VA$534.80–$628.072
VI$550.191
VT$535.141
WA$566.38–$644.342
WI$519.121
WV$496.381
WY$542.381

Explore 43251 on the national rate map →

Where does this rate apply?

Wyoming** is a Medicare payment area. Our Census mapping connects it to 205 cities and communities in Wyoming, 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 Wyoming →

Why are the office and facility amounts different?

For 43251 in Wyoming**, the physician’s office rate is $542.38 and the facility-setting rate is $169.63: a difference of $372.75.

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 43251 in Wyoming**. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$596.62

$542.38 × 110% = $596.62

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 43251 in Wyoming**.

PPRRVU2026_Oct_nonQPP.csv

5,180

Code
43251
Physician work
3.38
Practice expense
12.57
Malpractice
0.39

GPCI2026.csv

112

Locality
Wyoming**
Physician work
1.000
Practice expense
1.000
Malpractice
0.740
Office / nonfacility calculation for 43251 in Wyoming**
ComponentRVULocality factorAdjusted
Physician work3.38× 1.0003.3800
Practice expense12.57× 1.00012.5700
Malpractice0.39× 0.7400.2886
Total RVUs16.2386
Conversion factor× 33.4009

Office / nonfacility rate, Wyoming**$542.38

Open 43251 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work3.381
Practice expense12.571
Malpractice0.390.74

(3.38 × 1 + 12.57 × 1 + 0.39 × 0.74) × $33.4009 = $542.38

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work3.381
Practice expense1.411
Malpractice0.390.74

(3.38 × 1 + 1.41 × 1 + 0.39 × 0.74) × $33.4009 = $169.63

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

43251 · Office / nonfacility

$542.38

Effective 2026-10-01

The base rate is $77.96 higher than on 2025-10-01, moving from $464.42 to $542.38 (16.8%).

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

    $464.42changed to$542.38

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.47 changed to 3.38
    • Practice expense RVU 10.57 changed to 12.57
    • Malpractice RVU 0.43 changed to 0.39
    • Malpractice GPCI 0.739 changed to 0.740

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $464.42

    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$542.38$169.63RVU26D
2026-07-01$542.38$169.63RVU26C
2026-04-01$542.38$169.63RVU26B
2026-01-01$542.38$169.63RVU26A
2025-10-01$464.42$183.98RVU25D
2025-07-01$464.42$183.98RVU25C
2025-04-01$464.42$183.98RVU25B
2025-01-01$464.42$183.98RVU25A

43251 billing questions

When should this code be used instead of 43239?

Use this code when a snare is used to remove the lesion. Code 43239 describes biopsy sampling rather than snare removal.

Is the code reported once for each polyp?

No. Report the snare-removal service once for the EGD session, even when more than one lesion is removed by snare.

How does this differ from 43250?

This code describes snare removal. Code 43250 is used when a lesion is removed with hot biopsy forceps or bipolar cautery.

Can a separate biopsy code be reported during the same EGD?

A biopsy code describes sampling, while this code describes snare removal. Document each service and lesion clearly; do not assume both are separately reportable for the same lesion.

Can modifier 50 be used for lesions on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; the anatomy or descriptor does not support modifier 50.

Does Medicare pay an assistant or co-surgeon for this procedure?

The assistant-at-surgery statutory restriction prevents Medicare payment for an assistant. 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 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 43251PPRRVU2026_Oct_nonQPP.csv, line 5,180 (RVU26D)
Geographic factors for Wyoming**GPCI2026.csv, line 112 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet