CPT 43254
Global 000 ActiveEgd endo mucosal resection
CPT 43254 Billing & Documentation Guide
CPT code 43254 (Egd endo mucosal resection) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 4.75, a non-facility practice expense RVU of 1.81, and a malpractice RVU of 0.53, a total non-facility RVU of 7.09 and facility RVU of 7.09. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $240.14, though rates vary from $219.7 to $312.12 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43254, 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 43254 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 43254 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 43254
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 4.75 | 4.75 |
| Practice Expense RVU | 1.81 | 1.81 |
| Malpractice RVU | 0.53 | 0.53 |
| Total RVU | 7.09 | 7.09 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43254
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 | $245.47 | $245.47 | $237.1 - $272.77 | 29 |
| Florida | $253.77 | $253.77 | $243.06 - $266.36 | 3 |
| Georgia | $237.75 | $237.75 | $233.68 - $241.81 | 2 |
| Illinois | $251.46 | $251.46 | $241.52 - $261.15 | 4 |
| Michigan | $240.34 | $240.34 | $233.84 - $246.84 | 2 |
| North Carolina | $226.37 | $226.37 | $226.37 - $226.37 | 1 |
| New York | $257.68 | $257.68 | $228.53 - $273.56 | 5 |
| Ohio | $231.69 | $231.69 | $231.69 - $231.69 | 1 |
| Pennsylvania | $238.22 | $238.22 | $230.88 - $245.56 | 2 |
| Texas | $235.49 | $235.49 | $230.11 - $244.31 | 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 43254
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43254 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 |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 43254
What does CPT code 43254 mean? +
CPT code 43254 represents: Egd endo mucosal resection. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 43254? +
The 2026 Medicare national average non-facility payment for CPT 43254 is $240.14. Rates range from $219.7 to $312.12 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43254? +
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 43254? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team