$426.47
43216 uses hot biopsy forceps or bipolar cautery to remove the lesion; 43217 is the snare-removal service.
On this page
CMS RVU26D · Effective 2026-10-01
43216 Esophageal lesion removal Medicare reimbursement rates in Oklahoma
Flexible esophagoscopy removes an esophageal tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery during the procedure. Compare 43216 office and facility rates across CMS payment localities in Oklahoma.
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 43216 in Oklahoma?
Oklahoma 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
$413.02
1 of 1 localities have a supported rate.
Payment area: Oklahoma
One mapped payment locality.
Facility setting
$113.56
1 of 1 localities have a supported rate.
Payment area: Oklahoma
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.
Endoscopy
About 43216: Esophageal lesion removal by cautery
Flexible esophagoscopy removes an esophageal tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery during the procedure.
A gastroenterologist or other qualified endoscopist advances a flexible scope through the mouth to inspect the esophagus and remove a lesion with hot biopsy forceps or bipolar cautery. The service is used for therapeutic removal of an esophageal tumor, polyp, or other lesion, rather than inspection or tissue sampling alone. It is commonly performed in a facility-based endoscopy setting.
Report this code when the documented removal technique is hot biopsy forceps or bipolar cautery. The procedure note should identify the esophageal lesion and describe its removal and 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 service. CMS does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 43216
- 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 RVU2.24 · 16%
- Practice expense (office) RVU11.13 · 82%
- Malpractice RVU0.24 · 2%
255
Medicare services in 2024 · #4123 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.
43216 compared with similar codes
Office rates for Oklahoma, from the same CMS release.
No office rate
43211 is for endoscopic mucosal resection of an esophageal lesion. This code is selected for removal with hot biopsy forceps or bipolar cautery.
$708.81
43229 is used for lesion ablation. This code describes lesion removal using hot biopsy forceps or bipolar cautery.
$356.25
43202 is for biopsy during flexible esophagoscopy; this code is for therapeutic removal of an esophageal lesion.
Compare 43216 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
Oklahoma →
Office / nonfacility
$413.02
Facility
$113.56
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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 43216 in Oklahoma.
PPRRVU2026_Oct_nonQPP.csv
5,153
- Code
- 43216
- Physician work
- 2.24
- Practice expense
- 11.13
- Malpractice
- 0.24
GPCI2026.csv
86
- Locality
- Oklahoma
- Physician work
- 1.000
- Practice expense
- 0.893
- Malpractice
- 0.777
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.24 | × 1.000 | 2.2400 |
| Practice expense | 11.13 | × 0.893 | 9.9391 |
| Malpractice | 0.24 | × 0.777 | 0.1865 |
| Total RVUs | 12.3656 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Oklahoma$413.02
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.24 | 1 |
| Practice expense | 11.13 | 0.893 |
| Malpractice | 0.24 | 0.777 |
(2.24 × 1 + 11.13 × 0.893 + 0.24 × 0.777) × $33.4009 = $413.02
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.24 | 1 |
| Practice expense | 1.09 | 0.893 |
| Malpractice | 0.24 | 0.777 |
(2.24 × 1 + 1.09 × 0.893 + 0.24 × 0.777) × $33.4009 = $113.56
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.
43216 billing questions
How does this differ from 43217?
This code is for lesion removal with hot biopsy forceps or bipolar cautery. Use 43217 when a snare is used to remove the lesion.
When is 43211 a better choice?
43211 describes esophageal mucosal resection. Choose it when the documented therapeutic method is mucosal resection rather than removal with hot biopsy forceps or bipolar cautery.
Can a diagnostic biopsy be reported instead?
Use 43202 when the service is flexible esophagoscopy with biopsy rather than therapeutic lesion removal. The procedure documentation should support the service actually performed.
How does CMS price related endoscopies performed together?
CMS applies endoscopy-family pricing when related endoscopies are performed together. Payment is subject to that family pricing rather than treating every related endoscopy as an unrelated standalone service.
Which surgical modifiers or providers are permitted?
Modifier 50 is inappropriate. CMS does not pay an assistant at surgery for this service, and 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.
5,15043213,,Esophagoscopy retro balloon,A,,4.51,32.37,,1.57,,0.67,37.55,6.75,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15143214,,Esophagosc dilate balloon 30,A,,3.32,1.22,NA,1.22,,0.50,5.04,5.04,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15243215,,Esophagoscopy flex remove fb,A,,2.38,10.33,,1.08,,0.36,13.07,3.82,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15343216,,Esophagoscopy lesion removal,A,,2.24,11.13,,1.09,,0.24,13.61,3.57,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15443217,,Esophagoscopy snare les remv,A,,2.73,10.98,,1.23,,0.30,14.01,4.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15543220,,Esophagoscopy balloon <30mm,A,,1.95,26.47,,0.96,,0.26,28.68,3.17,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15643226,,Esoph endoscopy dilation,A,,2.18,9.89,,0.97,,0.36,12.43,3.51,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193