Billing code 43247: EGD removalMedicare rate & RVUs in Oregon
Reports therapeutic upper GI endoscopy to retrieve a foreign object from the esophagus, stomach, or proximal small bowel.
Medicare pays $421.18–$459.23 for 43247 in the office in Oregon, from Rest Of Oregon to Portland. 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 43247 covers
A gastroenterologist or other qualified endoscopist uses a flexible scope passed through the mouth to locate and retrieve a foreign object in the upper gastrointestinal tract. Common situations include removal of an impacted food bolus or a swallowed object from the esophagus or stomach. Retrieval may use an endoscopic grasping or capture device, with the approach guided by the object's location and characteristics. The service is generally performed in an endoscopy unit or hospital setting.
Report this code when the endoscopic service includes foreign-body removal, not for inspection alone. The same-session diagnostic examination that leads to removal is part of the therapeutic service; do not separately report 43235 for that inspection. Medicare 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 single endoscopic service. Medicare's statutory restriction bars payment for an assistant at surgery, and co-surgeon and team-surgery reporting 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.
Where 43247 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $459.23 | $160.51 |
| Rest Of Oregon | $421.18 | $153.37 |
How the 43247 rate is calculated
Each of 43247’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 · 43247
RVUs × geographic indexes × conversion factor
Work3.03
3.03 RVUs× 1.000 GPCI
Practice expense9.35
9.35 RVUs× 1.000 GPCI
Malpractice0.38
0.38 RVUs× 1.000 GPCI
Adjusted RVUs
12.7600
Conversion factor
$33.4009
Medicare rate
$426.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43247
The CMS indicators that decide how 43247 is paid alongside other services.
CMS payment indicators · 43247
EGD 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
43247 without 51 · national office
$426.20
EGD removal
43247-51 · Second procedure: 50%
$213.10
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%).
43247 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43235Upper GI endoscopy
- 43235 represents diagnostic EGD without therapeutic foreign-body removal. When retrieval is performed during the examination, report 43247 rather than separately reporting the diagnostic inspection.
- 43250Upper endoscopy
- 43250 describes cautery treatment of a tumor or polyp. Use 43247 for removal of a foreign object, not treatment of a tissue lesion.
- 43251EGD lesion removal
- 43251 describes snare removal of a lesion. Use 43247 when the endoscopic target is a foreign object rather than abnormal tissue.
43247 billing questions
When should 43247 be reported instead of 43235?
Report 43247 when the endoscopist retrieves a foreign object. Use 43235 for a diagnostic examination when no therapeutic removal is performed.
Can 43235 be billed with 43247 for the same examination?
The diagnostic inspection leading to foreign-body removal is included in the therapeutic service. Do not separately report 43235 for that same-session inspection.
How should removal of a lesion be distinguished from foreign-body retrieval?
43247 is for retrieval of a foreign object. Codes such as 43250 or 43251 describe treatment or removal of a tissue lesion, not foreign-body extraction.
Should modifier 50 be appended when an object is removed from a paired structure?
No. Modifier 50 is inappropriate for this endoscopic service.
What documentation supports reporting 43247?
Document the foreign object's location, the endoscopic retrieval performed, and the outcome. The record should distinguish retrieval from diagnostic inspection or treatment of a tissue lesion.
How are related endoscopies handled when performed together?
Medicare endoscopy family pricing applies when related endoscopies are performed together. The code is not an add-on code.
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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