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CPT code 43254: Endoscopic resection2026 Medicare rate & RVUs

Report this service when an upper endoscopy is used to remove a mucosal lesion by endoscopic mucosal resection rather than simple biopsy or snare removal.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.6K Medicare services in 2024

Medicare pays $236.81 for 43254 nationally in a facility.

Medicare rate · 43254

Endoscopic resection

Work RVUs
4.75
Total RVUs
7.09
Global days
000

National rate · 2026

$236.81

Facility setting, before claim adjustments.

See every locality for 43254 →Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 43254 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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.

Where 43254 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43254 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$221.57
Alaska*Unavailable$312.12
ArizonaUnavailable$232.39
ArkansasUnavailable$219.70
AtlantaUnavailable$241.81
AustinUnavailable$238.62
BakersfieldUnavailable$238.71
Baltimore/Surr. CntysUnavailable$247.96
BeaumontUnavailable$230.11
BrazoriaUnavailable$233.64

43254 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
43254 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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.

How the rate is built · 43254

RVUs × geographic indexes × conversion factor

Work4.75

4.75 RVUs× 1.000 GPCI

Practice expense1.81

1.81 RVUs× 1.000 GPCI

Malpractice0.53

0.53 RVUs× 1.000 GPCI

Adjusted RVUs

7.0900

Conversion factor

$33.4009

Medicare rate

$236.81

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 43254

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

CMS payment indicators · 43254

Endoscopic resection

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43254 without 51 · national facility

$236.81

Endoscopic resection

43254-51 · Second procedure: 50%

$118.41

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

43254 compared with similar codes

Compare codes · National

5 codes, side by side

  • 43254

    Endoscopic resection4.75 wRVU

    Not priced

  • 43251

    EGD lesion removal3.38 wRVU

    $545.77

  • 43250

    Upper endoscopy2.9 wRVU

    $498.68

  • 43239

    EGD with biopsy2.33 wRVU

    $418.85

  • 43235

    Upper GI endoscopy2.04 wRVU

    $322.65

How to choose

43251EGD lesion removal
43254 is for endoscopic mucosal resection. 43251 describes lesion removal by snare without that resection technique.
43250Upper endoscopy
43250 is used for lesion treatment by cautery. Select 43254 when the documented method is mucosal resection.
43239EGD with biopsy
43239 covers upper endoscopic biopsy for tissue sampling; 43254 is therapeutic removal of a mucosal lesion.
43235Upper GI endoscopy
43235 is diagnostic upper endoscopy without a separately described therapeutic mucosal resection.

Codes related to 43254

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

Codes related to 43254
CodeHow it relatesNational office range
Used instead
43251EGD lesion removalUpper endoscopic lesion removal by snare when mucosal resection is not performed.$480.25–$737.72
43250Upper endoscopyUpper endoscopic lesion treatment by cautery rather than mucosal resection.$437.19–$674.22
43239EGD with biopsyUpper endoscopic tissue sampling when biopsy, rather than therapeutic resection, is performed.$367.66–$569.97
43235Upper GI endoscopyDiagnostic upper endoscopy without mucosal resection.$284.01–$435.38

43254 billing questions

When should 43254 be chosen over 43251?

Choose 43254 when the endoscopist performs mucosal resection. Use 43251 for lesion removal by snare when the documented technique is not mucosal resection.

Can a biopsy be reported with the resection?

43254 represents the mucosal resection, not a separate diagnostic biopsy of that same resected lesion. Document any separate lesion sampled and review endoscopy family pricing when related procedures are performed during the session.

Does 43254 have a global period?

It has a 0-day global period. Same-day preoperative and postoperative care is included.

Should modifier 50 be appended for lesions on both sides?

No. Modifier 50 is inappropriate for this upper-GI endoscopic procedure.

Can an assistant or co-surgeon be billed?

An assistant at surgery is not paid under the statutory restriction. Co-surgeons and team surgery are not permitted.

What should the procedure note support?

Document the lesion's location, the mucosal resection technique, and the tissue removed. The record should make clear that the service was mucosal resection rather than biopsy or routine snare removal.

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

Show the CMS file lines behind this rate
RVUs for 43254PPRRVU2026_Oct_nonQPP.csv, line 5,183 (RVU26D)

Open CMS sourceHow we calculate rates

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