CPT code 43227: Esophagoscopy, endoscopic bleeding control2026 Medicare rate & RVUs in Missouri
Flexible transoral esophagoscopy with endoscopic hemostasis is reported when active esophageal bleeding is treated during the procedure, rather than merely evaluated.
Medicare pays $579.24–$628.99 for 43227 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 43227 covers
A flexible scope is passed through the mouth to inspect the esophagus and treat a bleeding site under direct visualization. Gastroenterologists commonly perform this service in a hospital or ambulatory endoscopy setting for active bleeding from esophageal mucosa or a lesion. Hemostasis may use an endoscopic technique such as injection, thermal treatment, or clips, depending on the source and clinical circumstances.
Report the service when the procedure includes treatment to control esophageal bleeding, not inspection alone. The operative report should identify the bleeding source and describe the hemostatic treatment. When related endoscopies are performed together, CMS endoscopy-family pricing applies. The 0-day global period includes same-day preoperative and postoperative care. The esophagus is not reported bilaterally, so modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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 43227 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$579.24 to $628.99
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $621.55 | $144.20 |
| Metropolitan St. Louis, MO | $628.99 | $145.03 |
| Rest of Missouri | $579.24 | $141.03 |
How the 43227 rate is calculated
Each of 43227’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 · 43227
RVUs × geographic indexes × conversion factor
Work2.82
2.82 RVUs× 1.000 GPCI
Practice expense16.44
16.44 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
19.6200
Conversion factor
$33.4009
Medicare rate
$655.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43227
The CMS indicators that decide how 43227 is paid alongside other services.
CMS payment indicators · 43227
Esophagoscopy, endoscopic bleeding control
| 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
43227 without 51 · national office
$655.33
Esophagoscopy, endoscopic bleeding control
43227-51 · Second procedure: 50%
$327.67
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%).
43227 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43243Variceal injectionEsophageal or gastric varices
- 43243 describes injection treatment of varices during upper endoscopy. Use 43227 for esophagoscopy with bleeding control when the procedure is not the variceal-injection service.
- 43244Variceal ligationEsophageal or gastric varices
- 43244 describes variceal ligation during upper endoscopy. 43227 is the esophagoscopy service for endoscopic bleeding control.
- 43229Esophageal ablationFlexible transoral scope
- 43229 is for ablation of an esophageal lesion. Choose 43227 when the documented service is controlling bleeding rather than ablating a lesion as the treatment objective.
- 43235Upper GI endoscopyDiagnostic, brushings or washings
- 43235 is a diagnostic upper endoscopy service. 43227 requires esophagoscopy with treatment to control bleeding.
43227 billing questions
When should 43227 be chosen over a diagnostic esophagoscopy?
Use 43227 when the esophagoscopy includes endoscopic treatment to control bleeding. Inspection without hemostasis is not this service.
How does 43227 differ from variceal injection or ligation?
43227 represents esophagoscopy with bleeding control. Codes 43243 and 43244 describe variceal treatment performed with upper endoscopy; choose based on the procedure actually performed.
What documentation supports reporting 43227?
Document the esophageal bleeding source and the method used to achieve hemostasis. The record should show treatment of bleeding, rather than observation alone.
Is same-day care included in the payment?
Yes. The 0-day global period includes preoperative and postoperative care on the procedure date.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 43227. Co-surgeons and team surgery are not permitted.
How are related endoscopies handled when performed together?
CMS endoscopy-family pricing applies when related endoscopies are performed together, so payment reflects the family-pricing rules.
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
Fee sheets
Put 43227 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet