CPT code 43215: Object removal2026 Medicare rate & RVUs in Texas
Reports flexible esophagoscopy to retrieve an object lodged in the esophagus, such as an impacted food bolus or swallowed object.
Medicare pays $404.64–$455.35 for 43215 in the office in Texas, from Beaumont to Austin. 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 43215 covers
A physician passes a flexible endoscope through the mouth to locate and retrieve an object lodged in the esophagus. Typical cases include an impacted food bolus or a swallowed object that remains in the esophagus; retrieval may use an endoscopic grasping device or net. Gastroenterologists commonly perform the service in a hospital or ambulatory endoscopy setting, sometimes urgently when swallowing is obstructed.
Report this service when the documented target is an object in the esophagus and the endoscopist removes it. The record should identify the object and its location, the retrieval performed, and the outcome. If the object is removed from the stomach or duodenum during a broader upper endoscopy, consider the corresponding upper-GI foreign-body removal code instead. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Bilateral adjustment is inappropriate for this anatomy; Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 43215 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$404.64 to $455.35
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $455.35 | $128.47 |
| Beaumont | $404.64 | $123.49 |
| Brazoria | $431.44 | $125.26 |
| Dallas | $434.18 | $126.46 |
| Fort Worth | $430.88 | $126.25 |
| Galveston | $432.70 | $125.91 |
| Houston | $439.29 | $132.50 |
| Rest Of Texas | $417.79 | $124.59 |
How the 43215 rate is calculated
Each of 43215’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 · 43215
RVUs × geographic indexes × conversion factor
Work2.38
2.38 RVUs× 1.000 GPCI
Practice expense10.33
10.33 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
13.0700
Conversion factor
$33.4009
Medicare rate
$436.55
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43215
The CMS indicators that decide how 43215 is paid alongside other services.
CMS payment indicators · 43215
Object 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
43215 without 51 · national office
$436.55
Object removal
43215-51 · Second procedure: 50%
$218.28
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%).
43215 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43247EGD removal
- This code is for retrieval of an object from the esophagus. Use 43247 for foreign-body removal during upper endoscopy involving the stomach or duodenum.
- 43200Esophagoscopy
- 43200 describes diagnostic flexible esophagoscopy, including permitted specimen collection. Choose this code when an object is actually retrieved from the esophagus.
- 43216Esophageal lesion removal
- 43216 treats a tumor, polyp, or other esophageal mucosal lesion. This code is for removal of a swallowed or lodged object, not an esophageal growth.
- 43217Esophageal lesion removal
- 43217 uses snare removal for an esophageal mucosal lesion. This code applies to extraction of an object from the esophagus.
43215 billing questions
When should this code be chosen over 43247?
Use this code for retrieval of an object from the esophagus by flexible esophagoscopy. Code 43247 describes foreign-body removal during upper endoscopy when the service involves the stomach or duodenum.
Can a diagnostic esophagoscopy be billed separately?
The examination needed to locate and retrieve the esophageal object is part of the removal service. Do not separately report a diagnostic scope for that same work.
How should the record support reporting this service?
Document the object, its esophageal location, the endoscopic retrieval method, and whether removal was successful. The note should distinguish an object from a mucosal lesion being treated.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
Does modifier 50 apply to esophageal object removal?
No. The esophagus is a single midline organ for this service, so bilateral adjustment is inappropriate.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. The procedure documentation should identify each service performed and its distinct target.
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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