$457.25
Choose 43251 for snare removal. Choose 43250 when the lesion is removed with hot biopsy forceps or bipolar cautery.
On this page
CMS RVU26D · Effective 2026-10-01
43251 EGD lesion removal Medicare reimbursement rates in Iowa
Reports upper endoscopy with snare removal of a polyp or other lesion in the esophagus, stomach, or duodenum. Compare 43251 office and facility rates across CMS payment localities in Iowa.
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 43251 in Iowa?
Iowa 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
$502.23
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$161.16
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
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 Iowa, from the same CMS release.
No office rate
43254 describes endoscopic mucosal resection. Use 43251 when the documented removal is by snare and is not an EMR.
$385.19
43239 is for biopsy sampling. This code is for removing a lesion with a snare, not merely taking tissue samples.
Compare 43251 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
Iowa →
Office / nonfacility
$502.23
Facility
$161.16
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,180
- Code
- 43251
- Physician work
- 3.38
- Practice expense
- 12.57
- Malpractice
- 0.39
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.38 | × 1.000 | 3.3800 |
| Practice expense | 12.57 | × 0.915 | 11.5015 |
| Malpractice | 0.39 | × 0.397 | 0.1548 |
| Total RVUs | 15.0364 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$502.23
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.38 | 1 |
| Practice expense | 12.57 | 0.915 |
| Malpractice | 0.39 | 0.397 |
(3.38 × 1 + 12.57 × 0.915 + 0.39 × 0.397) × $33.4009 = $502.23
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.38 | 1 |
| Practice expense | 1.41 | 0.915 |
| Malpractice | 0.39 | 0.397 |
(3.38 × 1 + 1.41 × 0.915 + 0.39 × 0.397) × $33.4009 = $161.16
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.
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.
5,17743249,,Esoph egd dilation <30 mm,A,,2.60,32.44,,1.18,,0.30,35.34,4.08,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,1784324F,,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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136