CPT 43754
Global 000 ActiveDx gastr intub w/asp spec
CPT 43754 Billing & Documentation Guide
CPT code 43754 (Dx gastr intub w/asp spec) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.44, a non-facility practice expense RVU of 9.61, and a malpractice RVU of 0.11, a total non-facility RVU of 10.16 and facility RVU of 1.43. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $353.13, though rates vary from $292.31 to $481.14 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43754, 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 43754 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 43754 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 43754
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.44 | 0.44 |
| Practice Expense RVU | 9.61 | 0.88 |
| Malpractice RVU | 0.11 | 0.11 |
| Total RVU | 10.16 | 1.43 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43754
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 | $397.02 | $52 | $368.71 - $481.14 | 29 |
| Florida | $343.9 | $51.34 | $327.08 - $358.13 | 3 |
| Georgia | $325.33 | $47.16 | $305.39 - $345.27 | 2 |
| Illinois | $331.92 | $50.17 | $313.5 - $350.96 | 4 |
| Michigan | $321.27 | $47.47 | $311.9 - $330.64 | 2 |
| North Carolina | $316.52 | $44.47 | $316.52 - $316.52 | 1 |
| New York | $378.48 | $53.18 | $322.21 - $404.11 | 5 |
| Ohio | $311.46 | $45.24 | $311.46 - $311.46 | 1 |
| Pennsylvania | $333.16 | $47.55 | $312.83 - $353.49 | 2 |
| Texas | $334.2 | $47.13 | $310.2 - $357.58 | 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 43754
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43754 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 | Standards of medical/surgical practice |
| 0216T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 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 |
| 12001 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 43754
What does CPT code 43754 mean? +
CPT code 43754 represents: Dx gastr intub w/asp spec. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 43754? +
The 2026 Medicare national average non-facility payment for CPT 43754 is $353.13. Rates range from $292.31 to $481.14 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43754? +
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 43754? +
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 May 31, 2026.
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