Billing code 43252: Optical endomicroscopyMedicare rate & RVUs in Oregon
Reports optical endomicroscopic imaging performed during upper endoscopy to assess gastrointestinal mucosa at microscopic resolution in real time.
Medicare pays $372.55–$405.49 for 43252 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 43252 covers
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.
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 43252 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $405.49 | $153.16 |
| Rest Of Oregon | $372.55 | $146.33 |
How the 43252 rate is calculated
Each of 43252’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 · 43252
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.89Practice expense 8.05Malpractice 0.35
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43252
The CMS indicators that decide how 43252 is paid alongside other services.
CMS payment indicators · 43252
Optical endomicroscopy
| 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
43252 without 51 · national office
$377.10
Optical endomicroscopy
43252-51 · Second procedure: 50%
$188.55
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%).
43252 compared with similar codes
Compare codes
43252 vs 43239 vs 43259 vs 43254: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43239EGD with biopsy
- Choose 43252 for optical endomicroscopic imaging; choose 43239 when the endoscopist obtains mucosal tissue for examination.
- 43259Endoscopic ultrasound
- Code 43259 describes endoscopic ultrasound examination of the specified upper gastrointestinal anatomy. Code 43252 uses optical imaging to assess mucosa at microscopic resolution.
- 43254Endoscopic resection
- Code 43254 describes endoscopic mucosal resection of a lesion. Code 43252 describes optical imaging, not lesion removal.
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 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
Fee sheets
Put 43252 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →