Billing code 43254: Endoscopic resectionMedicare rate & RVUs in Oregon
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 doesn’t publish an office rate for 43254 in Oregon.
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 9 sections
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 in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $241.53 |
| Rest Of Oregon | Unavailable | $231.31 |
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
Swap in your local Medicare rate.
Work 4.75Practice expense 1.81Malpractice 0.53
All indexes start 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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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%).
43254 compared with similar codes
Compare codes
43254 vs 43251 vs 43250 vs 43239 vs 43235: national Medicare rates
Swap in your local Medicare rate.
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.
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
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