$406.16
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.
On this page
CMS RVU26D · Effective 2026-10-01
43215 Object removal Medicare reimbursement rates in Utah
Reports flexible esophagoscopy to retrieve an object lodged in the esophagus, such as an impacted food bolus or swallowed object. Compare 43215 office and facility rates across CMS payment localities in Utah.
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 43215 in Utah?
Utah 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
$414.62
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
Facility setting
$124.20
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Gastrointestinal endoscopy
About 43215: Flexible esophagoscopy with object extraction
Reports flexible esophagoscopy to retrieve an object lodged in the esophagus, such as an impacted food bolus or swallowed object.
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.
CMS billing rules for 43215
- 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 RVU2.38 · 18%
- Practice expense (office) RVU10.33 · 79%
- Malpractice RVU0.36 · 3%
641
Medicare services in 2024 · #3341 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.
43215 compared with similar codes
Office rates for Utah, from the same CMS release.
$272.17
43200 describes diagnostic flexible esophagoscopy, including permitted specimen collection. Choose this code when an object is actually retrieved from the esophagus.
$431.46
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.
$444.92
43217 uses snare removal for an esophageal mucosal lesion. This code applies to extraction of an object from the esophagus.
Compare 43215 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
Utah →
Office / nonfacility
$414.62
Facility
$124.20
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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 43215 in Utah.
PPRRVU2026_Oct_nonQPP.csv
5,152
- Code
- 43215
- Physician work
- 2.38
- Practice expense
- 10.33
- Malpractice
- 0.36
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.38 | × 1.000 | 2.3800 |
| Practice expense | 10.33 | × 0.940 | 9.7102 |
| Malpractice | 0.36 | × 0.898 | 0.3233 |
| Total RVUs | 12.4135 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$414.62
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.38 | 1 |
| Practice expense | 10.33 | 0.94 |
| Malpractice | 0.36 | 0.898 |
(2.38 × 1 + 10.33 × 0.94 + 0.36 × 0.898) × $33.4009 = $414.62
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.38 | 1 |
| Practice expense | 1.08 | 0.94 |
| Malpractice | 0.36 | 0.898 |
(2.38 × 1 + 1.08 × 0.94 + 0.36 × 0.898) × $33.4009 = $124.20
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.
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 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.
5,14943212,,Esophagoscop stent placement,A,,3.32,1.25,NA,1.25,,0.51,5.08,5.08,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15043213,,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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985