$508.43
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 Endoscopic resection Medicare reimbursement rates in Indiana
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. Compare 43254 office and facility rates across CMS payment localities in Indiana.
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.
What does Medicare pay for 43254 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$223.30
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
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 Indiana, from the same CMS release.
$463.16
43250 is used for lesion treatment by cautery. Select 43254 when the documented method is mucosal resection.
$389.98
43239 covers upper endoscopic biopsy for tissue sampling; 43254 is therapeutic removal of a mucosal lesion.
$300.54
43235 is diagnostic upper endoscopy without a separately described therapeutic mucosal resection.
Compare 43254 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Indiana →
Office / nonfacility
Unavailable
Facility
$223.30
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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 Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,183
- Code
- 43254
- Physician work
- 4.75
- Practice expense
- 1.81
- Malpractice
- 0.53
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.75 | × 1.000 | 4.7500 |
| Practice expense | 1.81 | × 0.927 | 1.6779 |
| Malpractice | 0.53 | × 0.486 | 0.2576 |
| Total RVUs | 6.6855 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$223.30
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.75 | 1 |
| Practice expense | 1.81 | 0.927 |
| Malpractice | 0.53 | 0.486 |
(4.75 × 1 + 1.81 × 0.927 + 0.53 × 0.486) × $33.4009 = $223.30
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.
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
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915