CPT code 43254: Endoscopic resection, mucosal resection2026 Medicare rate & RVUs in South Dakota

In South Dakota, Medicare pays $225.06 for 43254 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43254 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 43254 covers

A gastroenterologist or other qualified endoscopist uses a flexible upper endoscope to resect a lesion arising in the lining of the esophagus, stomach, or duodenum. The technique may include lifting the lesion and removing it with an endoscopic snare or cap-based method. Typical clinical situations include resection of selected Barrett-associated dysplasia or a gastric or duodenal mucosal neoplasm, with the specimen submitted for pathology. The procedure is commonly performed in a hospital endoscopy unit or ambulatory endoscopy center.

Report 43254 when the documented therapeutic technique is mucosal resection, not merely tissue sampling or ordinary snare removal. The procedure note should identify the lesion and site, describe the resection method, and document the tissue removed. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate for this procedure. An assistant at surgery is not paid under the statutory restriction, and co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How South Dakota compares for 43254

Across 109 of 109 payment localities, the facility rate for 43254 runs from $219.70 in Arkansas to $312.12 in Alaska. South Dakota pays $225.06. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43254 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 43254 in every payment locality

How the 43254 rate is calculated

Each of 43254’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 43254

The CMS indicators that decide how 43254 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 43254

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 43254 has changed in South Dakota

Price 43254 for an earlier date of service

Where the South Dakota rate applies

South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.

• Aberdeen
• Agar
• Agency Village
• Akaska
• Albee
• Alcester
• Alexandria
• Allen

Browse all communities in South Dakota

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates