How much does Medicare pay for CPT 43251?

Medicare allowed an average of $419.64 per service and paid $333.85 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1866.03, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43251?

Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope with mechanical snare. It was billed 33,497 times to 32,493 Medicare beneficiaries by 1,183 providers in 2024.

Does 43251 pay differently in an office than a hospital?

Yes. The allowed amount averaged $385.74 in an office setting and $421.36 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 43251 most?

Gastroenterology, with 19,051 services from 710 clinicians. Next are Ambulatory Surgical Center, Internal Medicine, General Surgery.

CPT 43251

Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope with mechanical snare

$419.64Medicare-allowed amount per service, averaged across 33,497 services

Providers submitted

$1866.03

Asking price, not received

Medicare allowed

$419.64

The fee schedule figure

Medicare paid

$333.85

Balance is patient coinsurance

Providers submitted an average of $1866.03 for this code and Medicare allowed $419.64 — 4.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $333.85 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $385.74
Hospital / facility: $421.36

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,619 services were billed in an office setting and 31,878 in a facility.

Services: 33,497
Beneficiaries: 32,493
Providers billing it: 1,183
Total allowed: $14,056,681

What Medicare pays for CPT 43251

Across 33,497 services billed by 1,183 providers to 32,493 beneficiaries, Medicare allowed an average of $419.64 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 43251

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	19,051	18,420	$173.79	710
Ambulatory Surgical Center	13,252	12,907	$794.87	415
Internal Medicine	940	915	$177.31	42
General Surgery	190	189	$155.61	12
Hospitalist	48	46	$145.04	3
Anesthesiology	16	16	$567.45	1

43251 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	4,781	$492.59	$330.98	152
Florida	3,386	$427.49	$352.41	109
Texas	2,729	$408.86	$340.27	115
New York	1,933	$509.86	$356.93	64
Illinois	1,833	$395.29	$322.72	50
Pennsylvania	1,351	$379.74	$308.48	52
New Jersey	1,240	$450.60	$331.28	42
Arizona	1,150	$410.32	$337.55	29
North Carolina	1,095	$446.58	$388.84	45
Maryland	1,075	$503.05	$411.70	32
Nebraska	834	$308.84	$258.71	4
Iowa	820	$412.07	$363.28	12
Ohio	813	$391.05	$324.40	41
Virginia	789	$315.03	$239.01	26
Colorado	788	$446.79	$355.73	29
South Carolina	677	$301.24	$250.49	29
Oklahoma	650	$381.25	$323.53	17
Indiana	607	$331.40	$270.54	30
Massachusetts	586	$303.50	$219.97	28
Washington	568	$442.92	$331.38	30
Michigan	529	$359.61	$285.07	19
Missouri	511	$229.85	$191.03	17
Arkansas	395	$464.12	$411.16	15
Mississippi	389	$432.81	$398.16	15
Georgia	374	$500.88	$413.91	19
Louisiana	343	$480.84	$424.07	15
Wisconsin	315	$304.64	$250.22	14
Tennessee	308	$381.72	$338.46	13
Kansas	249	$410.84	$351.90	10
Alabama	246	$421.86	$385.07	14
New Hampshire	211	$349.49	$279.73	10
Connecticut	206	$493.85	$375.02	10
Kentucky	203	$305.52	$245.92	11
South Dakota	199	$415.40	$361.17	4
Utah	163	$234.94	$183.47	7
Delaware	159	$379.64	$291.01	7
Rhode Island	145	$498.72	$390.27	3
North Dakota	135	$130.58	$96.98	4
Nevada	134	$636.90	$519.79	6
Minnesota	122	$461.52	$358.14	6
Hawaii	107	$474.23	$356.11	5
Idaho	93	$327.49	$258.68	6
New Mexico	61	$471.27	$383.42	3
Alaska	47	$756.71	$472.97	3
Maine	32	$151.85	$116.23	2
Wyoming	29	$443.05	$357.94	2
West Virginia	26	$147.27	$123.41	2
Montana	25	$172.13	$109.40	2
Vermont	13	$146.98	$110.57	1
Oregon	12	$154.53	$121.81	1
District of Columbia	11	$159.60	$106.56	1

Related codes

43239Biopsy of esophagus$167.49
43235Diagnostic exam of esophagus$145.31
43249Balloon dilation of esophagus$337.40
43248Insertion of guide wire$223.15
43264Removal of stone or debris from bile or pancreatic duct$135.60
43274Insertion of stent into pancreatic or bile duct$392.61
43259Ultrasound exam of esophagus$230.50
43242Ultrasound guided needle aspiration or biopsy of esophagus$249.98
43255Control of bleeding of esophagus$200.78
43237Ultrasound exam of esophagus$204.08
43246Insertion of stomach tube$194.27
43238Ultrasound guided needle aspiration or biopsy of esophagus$222.24

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.