$581.95
43254 is for endoscopic mucosal resection. 43251 describes lesion removal by snare without that resection technique.
On this page
CMS RVU26D · Effective 2026-10-01
43254 in Redding
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$237.10
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Gastrointestinal endoscopy
About 43254: Upper endoscopy with mucosal resection
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.
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.
CMS billing rules for 43254
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.75 · 67%
- Practice expense (office) RVU1.81 · 26%
- Malpractice RVU0.53 · 7%
6.6K
Medicare services in 2024 · #1695 by national volume
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.
43254 compared with similar codes
Office rates for Redding, from the same CMS release.
$531.04
43250 is used for lesion treatment by cautery. Select 43254 when the documented method is mucosal resection.
$447.86
43239 covers upper endoscopic biopsy for tissue sampling; 43254 is therapeutic removal of a mucosal lesion.
$343.76
43235 is diagnostic upper endoscopy without a separately described therapeutic mucosal resection.
The same code, a different location
How does Redding compare?
43254 across payment areas
Same release and payment basis · bars start at $0
Redding · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Madera
California · 43254
Office
Unavailable
Facility
$237.10
No comparable office rate is available.
Merced
California · 43254
Office
Unavailable
Facility
$237.10
No comparable office rate is available.
Modesto
California · 43254
Office
Unavailable
Facility
$237.10
No comparable office rate is available.
Napa
California · 43254
Office
Unavailable
Facility
$257.32
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 43254
Office
Unavailable
Facility
$245.58
No comparable office rate is available.
Rest Of California
California · 43254
Office
Unavailable
Facility
$237.10
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 43254
Office
Unavailable
Facility
$242.87
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 43254
Office
Unavailable
Facility
$244.16
No comparable office rate is available.
Salinas
California · 43254
Office
Unavailable
Facility
$243.13
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 43254
Office
Unavailable
Facility
$245.31
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 43254
Office
Unavailable
Facility
$267.09
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 43254
Office
Unavailable
Facility
$266.49
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 43254
Office
Unavailable
Facility
$272.77
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 43254
Office
Unavailable
Facility
$270.31
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 43254
Office
Unavailable
Facility
$239.70
No comparable office rate is available.
Santa Cruz-Watsonville
California · 43254
Office
Unavailable
Facility
$244.93
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 43254
Office
Unavailable
Facility
$243.08
No comparable office rate is available.
Santa Rosa-Petaluma
California · 43254
Office
Unavailable
Facility
$247.14
No comparable office rate is available.
Stockton
California · 43254
Office
Unavailable
Facility
$237.10
No comparable office rate is available.
Vallejo
California · 43254
Office
Unavailable
Facility
$256.46
No comparable office rate is available.
Visalia
California · 43254
Office
Unavailable
Facility
$237.10
No comparable office rate is available.
Yuba City
California · 43254
Office
Unavailable
Facility
$237.10
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 43254
Office
Unavailable
Facility
$258.14
No comparable office rate is available.
Miami
Florida · 43254
Office
Unavailable
Facility
$266.36
No comparable office rate is available.
Chicago
Illinois · 43254
Office
Unavailable
Facility
$261.15
No comparable office rate is available.
Manhattan
New York · 43254
Office
Unavailable
Facility
$267.13
No comparable office rate is available.
Alaska*
Alaska · 43254
Office
Unavailable
Facility
$312.12
No comparable office rate is available.
Alabama
Alabama · 43254
Office
Unavailable
Facility
$221.57
No comparable office rate is available.
Arkansas
Arkansas · 43254
Office
Unavailable
Facility
$219.70
No comparable office rate is available.
Arizona
Arizona · 43254
Office
Unavailable
Facility
$232.39
No comparable office rate is available.
Colorado
Colorado · 43254
Office
Unavailable
Facility
$238.71
No comparable office rate is available.
Connecticut
Connecticut · 43254
Office
Unavailable
Facility
$248.36
No comparable office rate is available.
Delaware
Delaware · 43254
Office
Unavailable
Facility
$235.09
No comparable office rate is available.
Fort Lauderdale
Florida · 43254
Office
Unavailable
Facility
$251.90
No comparable office rate is available.
Rest Of Florida
Florida · 43254
Office
Unavailable
Facility
$243.06
No comparable office rate is available.
Atlanta
Georgia · 43254
Office
Unavailable
Facility
$241.81
No comparable office rate is available.
Rest Of Georgia
Georgia · 43254
Office
Unavailable
Facility
$233.68
No comparable office rate is available.
Hawaii, Guam
Hawaii · 43254
Office
Unavailable
Facility
$237.64
No comparable office rate is available.
Iowa
Iowa · 43254
Office
Unavailable
Facility
$221.00
No comparable office rate is available.
Idaho
Idaho · 43254
Office
Unavailable
Facility
$222.65
No comparable office rate is available.
East St. Louis
Illinois · 43254
Office
Unavailable
Facility
$249.93
No comparable office rate is available.
Rest Of Illinois
Illinois · 43254
Office
Unavailable
Facility
$241.52
No comparable office rate is available.
Suburban Chicago
Illinois · 43254
Office
Unavailable
Facility
$253.22
No comparable office rate is available.
Indiana
Indiana · 43254
Office
Unavailable
Facility
$223.30
No comparable office rate is available.
Kansas
Kansas · 43254
Office
Unavailable
Facility
$222.23
No comparable office rate is available.
Kentucky
Kentucky · 43254
Office
Unavailable
Facility
$228.60
No comparable office rate is available.
New Orleans
Louisiana · 43254
Office
Unavailable
Facility
$235.65
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 43254
Office
Unavailable
Facility
$229.12
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 43254
Office
Unavailable
Facility
$253.10
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 43254
Office
Unavailable
Facility
$238.96
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 43254
Office
Unavailable
Facility
$247.96
No comparable office rate is available.
Rest Of Maryland
Maryland · 43254
Office
Unavailable
Facility
$237.67
No comparable office rate is available.
Rest Of Maine
Maine · 43254
Office
Unavailable
Facility
$225.28
No comparable office rate is available.
Southern Maine
Maine · 43254
Office
Unavailable
Facility
$229.74
No comparable office rate is available.
Detroit
Michigan · 43254
Office
Unavailable
Facility
$246.84
No comparable office rate is available.
Rest Of Michigan
Michigan · 43254
Office
Unavailable
Facility
$233.84
No comparable office rate is available.
Minnesota
Minnesota · 43254
Office
Unavailable
Facility
$226.10
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 43254
Office
Unavailable
Facility
$232.72
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 43254
Office
Unavailable
Facility
$233.95
No comparable office rate is available.
Rest Of Missouri
Missouri · 43254
Office
Unavailable
Facility
$228.01
No comparable office rate is available.
Mississippi
Mississippi · 43254
Office
Unavailable
Facility
$223.79
No comparable office rate is available.
Montana**
Montana · 43254
Office
Unavailable
Facility
$236.78
No comparable office rate is available.
North Carolina
North Carolina · 43254
Office
Unavailable
Facility
$226.37
No comparable office rate is available.
North Dakota**
North Dakota · 43254
Office
Unavailable
Facility
$226.30
No comparable office rate is available.
Nebraska
Nebraska · 43254
Office
Unavailable
Facility
$221.15
No comparable office rate is available.
New Hampshire
New Hampshire · 43254
Office
Unavailable
Facility
$237.08
No comparable office rate is available.
Northern Nj
New Jersey · 43254
Office
Unavailable
Facility
$257.68
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 43254
Office
Unavailable
Facility
$250.44
No comparable office rate is available.
New Mexico
New Mexico · 43254
Office
Unavailable
Facility
$235.35
No comparable office rate is available.
Nevada**
Nevada · 43254
Office
Unavailable
Facility
$233.92
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 43254
Office
Unavailable
Facility
$273.56
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 43254
Office
Unavailable
Facility
$253.41
No comparable office rate is available.
Queens
New York · 43254
Office
Unavailable
Facility
$265.79
No comparable office rate is available.
Rest Of New York
New York · 43254
Office
Unavailable
Facility
$228.53
No comparable office rate is available.
Ohio
Ohio · 43254
Office
Unavailable
Facility
$231.69
No comparable office rate is available.
Oklahoma
Oklahoma · 43254
Office
Unavailable
Facility
$226.40
No comparable office rate is available.
Portland
Oregon · 43254
Office
Unavailable
Facility
$241.53
No comparable office rate is available.
Rest Of Oregon
Oregon · 43254
Office
Unavailable
Facility
$231.31
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 43254
Office
Unavailable
Facility
$245.56
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 43254
Office
Unavailable
Facility
$230.88
No comparable office rate is available.
Puerto Rico
Puerto Rico · 43254
Office
Unavailable
Facility
$237.21
No comparable office rate is available.
Rhode Island
Rhode Island · 43254
Office
Unavailable
Facility
$239.91
No comparable office rate is available.
South Carolina
South Carolina · 43254
Office
Unavailable
Facility
$229.56
No comparable office rate is available.
South Dakota**
South Dakota · 43254
Office
Unavailable
Facility
$225.06
No comparable office rate is available.
Tennessee
Tennessee · 43254
Office
Unavailable
Facility
$223.11
No comparable office rate is available.
Austin
Texas · 43254
Office
Unavailable
Facility
$238.62
No comparable office rate is available.
Beaumont
Texas · 43254
Office
Unavailable
Facility
$230.11
No comparable office rate is available.
Brazoria
Texas · 43254
Office
Unavailable
Facility
$233.64
No comparable office rate is available.
Dallas
Texas · 43254
Office
Unavailable
Facility
$235.48
No comparable office rate is available.
Fort Worth
Texas · 43254
Office
Unavailable
Facility
$235.11
No comparable office rate is available.
Galveston
Texas · 43254
Office
Unavailable
Facility
$234.61
No comparable office rate is available.
Houston
Texas · 43254
Office
Unavailable
Facility
$244.31
No comparable office rate is available.
Rest Of Texas
Texas · 43254
Office
Unavailable
Facility
$232.01
No comparable office rate is available.
Utah
Utah · 43254
Office
Unavailable
Facility
$231.38
No comparable office rate is available.
Virginia
Virginia · 43254
Office
Unavailable
Facility
$230.58
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 43254
Office
Unavailable
Facility
$237.21
No comparable office rate is available.
Vermont
Vermont · 43254
Office
Unavailable
Facility
$227.46
No comparable office rate is available.
Rest Of Washington
Washington · 43254
Office
Unavailable
Facility
$237.85
No comparable office rate is available.
Seattle (King Cnty)
Washington · 43254
Office
Unavailable
Facility
$255.23
No comparable office rate is available.
Wisconsin
Wisconsin · 43254
Office
Unavailable
Facility
$222.02
No comparable office rate is available.
West Virginia
West Virginia · 43254
Office
Unavailable
Facility
$236.52
No comparable office rate is available.
Wyoming**
Wyoming · 43254
Office
Unavailable
Facility
$232.21
No comparable office rate is available.
See how rates vary across the country
43254 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Redding is a Medicare payment area. Our Census mapping connects it to 32 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 43254 in Redding. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$260.81
$237.10 × 110% = $260.81
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43254 in Redding.
PPRRVU2026_Oct_nonQPP.csv
5,183
- Code
- 43254
- Physician work
- 4.75
- Practice expense
- 1.81
- Malpractice
- 0.53
GPCI2026.csv
19
- Locality
- Redding
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.75 | × 1.017 | 4.8307 |
| Practice expense | 1.81 | × 1.096 | 1.9838 |
| Malpractice | 0.53 | × 0.536 | 0.2841 |
| Total RVUs | 7.0986 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Redding$237.10
Open 43254 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.75 | 1.017 |
| Practice expense | 1.81 | 1.096 |
| Malpractice | 0.53 | 0.536 |
(4.75 × 1.017 + 1.81 × 1.096 + 0.53 × 0.536) × $33.4009 = $237.10
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
43254 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $237.10 | RVU26D |
| 2026-07-01 | Not available in this setting | $237.10 | RVU26C |
| 2026-04-01 | Not available in this setting | $237.10 | RVU26B |
| 2026-01-01 | Not available in this setting | $237.10 | RVU26A |
| 2025-10-01 | Not available in this setting | $259.69 | RVU25D |
| 2025-07-01 | Not available in this setting | $259.69 | RVU25C |
| 2025-04-01 | Not available in this setting | $259.69 | RVU25B |
| 2025-01-01 | Not available in this setting | $259.69 | RVU25A |
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,18043251,,Egd remove lesion snare,A,,3.38,12.57,,1.41,,0.39,16.34,5.18,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18143252,,Egd optical endomicroscopy,A,,2.89,8.05,,1.25,,0.35,11.29,4.49,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18243253,,Egd us transmural injxn/mark,A,,4.61,1.78,NA,1.78,,0.50,6.89,6.89,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18343254,,Egd endo mucosal resection,A,,4.75,1.81,NA,1.81,,0.53,7.09,7.09,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18443255,,Egd control bleeding any,A,,3.47,16.77,,1.44,,0.39,20.63,5.30,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18543257,,Egd w/thrml txmnt gerd,A,,4.05,1.62,NA,1.62,,0.45,6.12,6.12,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18643259,,Egd us exam duodenum/jejunum,A,,3.94,1.58,NA,1.58,,0.43,5.95,5.95,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536
2001112,CA,62,RIVERSIDE-SAN BERNARDINO-ONTARIO,1.018,1.096,0.853
2101112,CA,63,SACRAMENTO-ROSEVILLE-FOLSOM,1.036,1.163,0.536
2201112,CA,64,SALINAS,1.031,1.159,0.536