CPT 43756
Global 000 ActiveDx duod intub w/asp spec
CPT 43756 Billing & Documentation Guide
CPT code 43756 (Dx duod 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 0.75, a non-facility practice expense RVU of 8.26, and a malpractice RVU of 0.07, a total non-facility RVU of 9.08 and facility RVU of 1.41. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $315.49, though rates vary from $263.25 to $426.89 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43756, 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 43756 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 43756 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 43756
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.75 | 0.75 |
| Practice Expense RVU | 8.26 | 0.59 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 9.08 | 1.41 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43756
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 | $353.67 | $50.54 | $329.11 - $426.89 | 29 |
| Florida | $306.42 | $49.37 | $292.32 - $318.17 | 3 |
| Georgia | $291.09 | $46.69 | $273.93 - $308.24 | 2 |
| Illinois | $296.19 | $48.65 | $280.59 - $312.71 | 4 |
| Michigan | $287.41 | $46.85 | $279.58 - $295.23 | 2 |
| North Carolina | $283.95 | $44.93 | $283.95 - $283.95 | 1 |
| New York | $337.2 | $51.4 | $288.79 - $359.03 | 5 |
| Ohio | $279.3 | $45.4 | $279.3 - $279.3 | 1 |
| Pennsylvania | $298.01 | $47.08 | $280.53 - $315.49 | 2 |
| Texas | $298.98 | $46.76 | $278.28 - $319.07 | 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 43756
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43756 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 12002 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12004 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 43756
What does CPT code 43756 mean? +
CPT code 43756 represents: Dx duod intub w/asp spec. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 43756? +
The 2026 Medicare national average non-facility payment for CPT 43756 is $315.49. Rates range from $263.25 to $426.89 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43756? +
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 43756? +
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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