Billing code 43217: Esophageal lesion removalMedicare rate & RVUs in Ohio
Flexible transoral esophagoscopy with snare excision is reported when a gastroenterologist removes an esophageal polyp, tumor, or other lesion using a snare.
Medicare pays $436.12 for 43217 in the office in Ohio (Ohio). Which amount applies depends on the service address.
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 9 sections
What 43217 covers
A gastroenterologist advances a flexible endoscope through the mouth to examine the esophagus, then uses a snare loop to capture and remove a polyp, tumor, or other lesion. The service is performed in an endoscopy suite, hospital outpatient department, or ambulatory surgery center. The defining feature is snare removal of an esophageal lesion, rather than sampling it with biopsy forceps or treating it with another technique.
Report the code when the procedure record identifies the esophageal lesion and documents removal with a snare. The minor-procedure global period is 0 days, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for it, and 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.
43217 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $436.12 | $138.79 |
How the 43217 rate is calculated
Each of 43217’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 · 43217
RVUs × geographic indexes × conversion factor
Work2.73
2.73 RVUs× 1.000 GPCI
Practice expense10.98
10.98 RVUs× 1.000 GPCI
Malpractice0.30
0.30 RVUs× 1.000 GPCI
Adjusted RVUs
14.0100
Conversion factor
$33.4009
Medicare rate
$467.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43217
The CMS indicators that decide how 43217 is paid alongside other services.
CMS payment indicators · 43217
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
43217 without 51 · national office
$467.95
Esophageal lesion removal
43217-51 · Second procedure: 50%
$233.98
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%).
43217 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43216Esophageal lesion removal
- Choose 43217 for snare removal; choose 43216 when the lesion is removed with hot biopsy forceps or bipolar cautery.
- 43211Esophageal resection
- 43211 represents endoscopic mucosal resection of an esophageal lesion. This code is for snare removal without that technique.
- 43251EGD lesion removal
- 43251 is the snare-removal option for an upper gastrointestinal endoscopy that includes the stomach or duodenum; this code is for esophagoscopy.
- 43202Esophageal biopsy
- 43202 is used for esophageal biopsy sampling. This code applies when the lesion is removed with a snare rather than sampled.
43217 billing questions
How is this different from 43216?
This code is for snare removal. Code 43216 describes lesion removal using hot biopsy forceps or bipolar cautery.
When should 43211 be considered instead?
Use 43211 when the esophageal lesion is removed by endoscopic mucosal resection. The documented removal technique distinguishes it from snare excision under this code.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this service.
What happens if related endoscopies are performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The procedure record should support each service reported.
Does this code include same-day postoperative care?
Yes. It has a 0-day global period, which 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 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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