$447.86
Choose 43252 for optical endomicroscopic imaging; choose 43239 when the endoscopist obtains mucosal tissue for examination.
On this page
CMS RVU26D · Effective 2026-10-01
43252 Optical endomicroscopy Medicare reimbursement rates in Connecticut
Reports optical endomicroscopic imaging performed during upper endoscopy to assess gastrointestinal mucosa at microscopic resolution in real time. Compare 43252 office and facility rates across CMS payment localities in Connecticut.
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.
What does Medicare pay for 43252 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$402.19
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$157.57
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Gastrointestinal endoscopy
About 43252: EGD with optical endomicroscopy
Reports optical endomicroscopic imaging performed during upper endoscopy to assess gastrointestinal mucosa at microscopic resolution in real time.
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.
CMS billing rules for 43252
- 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 RVU2.89 · 26%
- Practice expense (office) RVU8.05 · 71%
- Malpractice RVU0.35 · 3%
4.5K
Medicare services in 2024 · #1951 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.
43252 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
Code 43259 describes endoscopic ultrasound examination of the specified upper gastrointestinal anatomy. Code 43252 uses optical imaging to assess mucosa at microscopic resolution.
No office rate
Code 43254 describes endoscopic mucosal resection of a lesion. Code 43252 describes optical imaging, not lesion removal.
Compare 43252 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
$402.19
Facility
$157.57
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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 43252 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,181
- Code
- 43252
- Physician work
- 2.89
- Practice expense
- 8.05
- Malpractice
- 0.35
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.89 | × 1.020 | 2.9478 |
| Practice expense | 8.05 | × 1.077 | 8.6699 |
| Malpractice | 0.35 | × 1.210 | 0.4235 |
| Total RVUs | 12.0412 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$402.19
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.89 | 1.02 |
| Practice expense | 8.05 | 1.077 |
| Malpractice | 0.35 | 1.21 |
(2.89 × 1.02 + 8.05 × 1.077 + 0.35 × 1.21) × $33.4009 = $402.19
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.89 | 1.02 |
| Practice expense | 1.25 | 1.077 |
| Malpractice | 0.35 | 1.21 |
(2.89 × 1.02 + 1.25 × 1.077 + 0.35 × 1.21) × $33.4009 = $157.57
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.
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 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.
5,1784324F,,Pt queried prkns complic,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,17943250,,Egd cautery tumor polyp,A,,2.90,11.61,,1.25,,0.42,14.93,4.57,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18043251,,Egd remove lesion snare,A,,3.38,12.57,,1.41,,0.39,16.34,5.18,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18143252,,Egd optical endomicroscopy,A,,2.89,8.05,,1.25,,0.35,11.29,4.49,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18243253,,Egd us transmural injxn/mark,A,,4.61,1.78,NA,1.78,,0.50,6.89,6.89,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18343254,,Egd endo mucosal resection,A,,4.75,1.81,NA,1.81,,0.53,7.09,7.09,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18443255,,Egd control bleeding any,A,,3.47,16.77,,1.44,,0.39,20.63,5.30,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808