CPT 43252
Global 000 ActiveEgd optical endomicroscopy
CPT 43252 Billing & Documentation Guide
CPT code 43252 (Egd optical endomicroscopy) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.89, a non-facility practice expense RVU of 8.05, and a malpractice RVU of 0.35, a total non-facility RVU of 11.29 and facility RVU of 4.49. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $389.12, though rates vary from $333.51 to $501.13 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43252, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 43252 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 43252 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 43252
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.89 | 2.89 |
| Practice Expense RVU | 8.05 | 1.25 |
| Malpractice RVU | 0.35 | 0.35 |
| Total RVU | 11.29 | 4.49 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43252
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $424.49 | $155.73 | $399.13 - $501.13 | 29 |
| Florida | $389.06 | $161.18 | $371.15 - $405.99 | 3 |
| Georgia | $367.17 | $150.5 | $350.3 - $384.04 | 2 |
| Illinois | $379.01 | $159.55 | $360.29 - $394.26 | 4 |
| Michigan | $365.46 | $152.19 | $355.21 - $375.71 | 2 |
| North Carolina | $354.86 | $142.95 | $354.86 - $354.86 | 1 |
| New York | $416.96 | $163.58 | $360.18 - $444.11 | 5 |
| Ohio | $353.8 | $146.43 | $353.8 - $353.8 | 1 |
| Pennsylvania | $373.26 | $150.79 | $354.41 - $392.11 | 2 |
| Texas | $372.63 | $149.02 | $352.07 - $391.55 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 43252
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43252 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00520 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00731 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00732 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00740 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00810 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00811 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00812 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00813 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0632T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0652T | Column 1 (primary), can be billed with modifier | No | CPT Separate procedure definition |
Frequently Asked Questions, CPT 43252
What does CPT code 43252 mean? +
CPT code 43252 represents: Egd optical endomicroscopy. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 43252? +
The 2026 Medicare national average non-facility payment for CPT 43252 is $389.12. Rates range from $333.51 to $501.13 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43252? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 43252? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on April 17, 2026.
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