$302.00–$335.53
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.
On this page
CMS RVU26D · Effective 2026-10-01
43247 EGD removal Medicare reimbursement rates in Pennsylvania
Reports therapeutic upper GI endoscopy to retrieve a foreign object from the esophagus, stomach, or proximal small bowel. Compare 43247 office and facility rates across CMS payment localities in Pennsylvania.
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 43247 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$399.89–$443.27
2 of 2 localities have a supported rate.
Facility setting
$153.06–$163.37
2 of 2 localities have a supported rate.
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 endoscopy
About 43247: Upper GI endoscopic foreign-body removal
Reports therapeutic upper GI endoscopy to retrieve a foreign object from the esophagus, stomach, or proximal small bowel.
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.
CMS billing rules for 43247
- 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 RVU3.03 · 24%
- Practice expense (office) RVU9.35 · 73%
- Malpractice RVU0.38 · 3%
23.3K
Medicare services in 2024 · #1080 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.
43247 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$466.11–$519.03
43250 describes cautery treatment of a tumor or polyp. Use 43247 for removal of a foreign object, not treatment of a tissue lesion.
$510.63–$567.53
43251 describes snare removal of a lesion. Use 43247 when the endoscopic target is a foreign object rather than abnormal tissue.
Compare 43247 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$443.27
Facility
$163.37
Rest Of Pennsylvania →
Office / nonfacility
$399.89
Facility
$153.06
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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 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.
5,17243244,,Egd varices ligation,A,,4.29,1.69,NA,1.69,,0.47,6.45,6.45,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17343245,,Egd dilate stricture,A,,3.00,16.19,,1.28,,0.42,19.61,4.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17443246,,Egd place gastrostomy tube,A,,3.47,1.34,NA,1.34,,0.53,5.34,5.34,0,000,0.00,0.00,0.00,3,0,0,2,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17543247,,Egd remove foreign body,A,,3.03,9.35,,1.30,,0.38,12.76,4.71,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17643248,,Egd guide wire insertion,A,,2.84,10.53,,1.25,,0.34,13.71,4.43,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17743249,,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