CPT 43291
Global 000 ActiveEgd flx trnsorl rmvl balo
CPT 43291 Billing & Documentation Guide
CPT code 43291 (Egd flx trnsorl rmvl balo) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.73, a non-facility practice expense RVU of 12.14, and a malpractice RVU of 0.3, a total non-facility RVU of 15.17 and facility RVU of 4.26. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $524.81, though rates vary from $444.66 to $691.3 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43291, 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 43291 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 43291 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 43291
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.73 | 2.73 |
| Practice Expense RVU | 12.14 | 1.23 |
| Malpractice RVU | 0.3 | 0.3 |
| Total RVU | 15.17 | 4.26 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43291
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 | $579.69 | $148.5 | $542.52 - $691.3 | 29 |
| Florida | $517.53 | $151.91 | $493.89 - $538.64 | 3 |
| Georgia | $490.15 | $142.5 | $464.82 - $515.47 | 2 |
| Illinois | $502.45 | $150.35 | $477.06 - $526.01 | 4 |
| Michigan | $486.04 | $143.87 | $472.71 - $499.37 | 2 |
| North Carolina | $475.91 | $135.92 | $475.91 - $475.91 | 1 |
| New York | $561.49 | $154.96 | $483.44 - $597.75 | 5 |
| Ohio | $471.49 | $138.79 | $471.49 - $471.49 | 1 |
| Pennsylvania | $499.89 | $142.96 | $472.89 - $526.89 | 2 |
| Texas | $500.2 | $141.44 | $469.49 - $529.25 | 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 43291
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43291 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 0813T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11000 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11001 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11004 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11005 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 43291
What does CPT code 43291 mean? +
CPT code 43291 represents: Egd flx trnsorl rmvl balo. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 43291? +
The 2026 Medicare national average non-facility payment for CPT 43291 is $524.81. Rates range from $444.66 to $691.3 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43291? +
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 43291? +
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 June 2, 2026.
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