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CPT code 43227: Esophagoscopy, endoscopic bleeding control2026 Medicare rate & RVUs in Puerto Rico

Flexible transoral esophagoscopy with endoscopic hemostasis is reported when active esophageal bleeding is treated during the procedure, rather than merely evaluated.

CMS RVU26DEffective Oct 1, 2026One payment locality116 Medicare services in 2024

In Puerto Rico, Medicare pays $661.19 for 43227 in the office and $147.23 when it’s performed in a hospital or facility.

$661.19Office (non-facility)
$147.23Hospital or facility
+0.9%vs the national office rate ($655.33)

Check a contract rate as a % of Medicare · 43227 nationwide

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

We’ll open 43227 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 43227 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Puerto Rico compares for 43227

Across 109 of 109 payment localities, the office rate for 43227 runs from $572.07 in Arkansas to $902.81 in San Benito County, CA. Puerto Rico pays $661.19. The RVUs are the same everywhere; the geographic indexes change the dollars.

43227 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$661.19
  2. Los Angeles, CA · California$755.63+$94.44
  3. Washington, DC area · District of Columbia$759.51+$98.32
  4. Miami, FL · Florida$696.22+$35.03
  5. Chicago, IL · Illinois$674.30+$13.11
  6. Manhattan, NY · New York$757.36+$96.17
  7. Alaska · Alaska$732.71+$71.52

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

43227 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$581.47$136.65
ArkansasArkansas$572.07$135.39
ArizonaArizona$636.57$143.97
Bakersfield, CACalifornia$705.13$147.96
Chico, CACalifornia$704.06$146.90
El Centro, CACalifornia$704.12$146.96
Fresno, CACalifornia$704.06$146.90
Hanford, CACalifornia$704.06$146.90

43227 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$572.07

$803.44

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
43227 office rate range by state
State / territoryOffice rate rangeLocalities
AK$732.711
AL$581.471
AR$572.071
AZ$636.571
CA$704.06–$902.8129
CO$688.971
CT$702.021
DC$759.511
DE$647.991
FL$637.21–$696.223
GA$598.33–$666.812
GU$725.491
HI$725.491
IA$601.401
ID$605.061
IL$614.32–$680.094
IN$609.061
KS$596.651
KY$593.351
LA$591.67–$624.562
MA$683.49–$764.392
MD$661.87–$759.513
ME$606.85–$645.952
MI$609.10–$644.362
MN$662.781
MO$579.24–$628.993
MS$575.861
MT$655.301
NC$614.191
ND$648.181
NE$605.561
NH$676.341
NJ$710.78–$749.942
NM$612.171
NV$653.871
NY$624.30–$775.445
OH$607.651
OK$593.891
OR$649.56–$714.712
PA$609.64–$681.862
PR$661.191
RI$673.941
SC$611.791
SD$647.341
TN$599.791
TX$605.05–$685.998
UT$621.151
VA$642.46–$759.512
VI$661.191
VT$643.891
WA$682.78–$782.482
WI$623.941
WV$588.571
WY$652.201

See 43227 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,157

Code
43227
Physician work
2.82
Practice expense
16.44
Malpractice
0.36

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 43227 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.82× 1.0002.8200
Practice expense16.44× 1.01116.6208
Malpractice0.36× 0.9850.3546
Total RVUs19.7954
Conversion factor× 33.4009

Office rate, Puerto Rico$661.19

Office: (2.82 × 1 + 16.44 × 1.011 + 0.36 × 0.985) × $33.4009 = $661.19

Facility: (2.82 × 1 + 1.22 × 1.011 + 0.36 × 0.985) × $33.4009 = $147.23

Open 43227 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 43227

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

Codes related to 43227
CodeHow it relatesOffice range, Puerto Rico
Used instead
43243Variceal injection, esophageal or gastric varicesVariceal injection performed with upper endoscopy rather than esophagoscopy.No office rate
43244Variceal ligation, esophageal or gastric varicesVariceal ligation performed with upper endoscopy rather than esophagoscopy.No office rate
43229Esophageal ablation, flexible transoral scopeEsophageal lesion ablation when lesion treatment, rather than bleeding control, is the procedure.$788.91

How 43227 has changed in Puerto Rico

43227 · Office / nonfacility

$661.19

Effective 2026-10-01

The base rate is $100.90 higher than on 2025-10-01, moving from $560.29 to $661.19 (18.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $560.29changed to$661.19

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.89 changed to 2.82
    • Practice expense RVU 13.98 changed to 16.44
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $593.67changed to$560.29

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 14.48 changed to 13.98
    • Malpractice RVU 0.37 changed to 0.36

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $583.98changed to$593.67

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $611.38changed to$583.98

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 14.68 changed to 14.48
    • Malpractice RVU 0.36 changed to 0.37
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $607.60changed to$611.38

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $643.93changed to$607.60

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 15.26 changed to 14.68
    • Malpractice RVU 0.34 changed to 0.36
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $671.08changed to$643.93

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 15.89 changed to 15.26
    • Malpractice RVU 0.33 changed to 0.34

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $642.47changed to$671.08

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 14.48 changed to 15.89
    • Malpractice RVU 0.32 changed to 0.33
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $644.66changed to$642.47

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 14.51 changed to 14.48
    • Malpractice RVU 0.39 changed to 0.32
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $649.76changed to$644.66

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 14.68 changed to 14.51
    • Malpractice RVU 0.38 changed to 0.39

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $559.38changed to$649.76

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 14.54 changed to 14.68
    • Malpractice RVU 0.39 changed to 0.38
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $523.56changed to$559.38

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.99 changed to 2.89
    • Practice expense RVU 16.33 changed to 14.54
    • Malpractice RVU 0.41 changed to 0.39
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $311.91changed to$523.56

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.88 changed to 16.33
    • Malpractice RVU 0.46 changed to 0.41

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $310.36changed to$311.91

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $305.14changed to$310.36

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.82 changed to 7.88
    • Malpractice RVU 0.43 changed to 0.46
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    No ratechanged to$305.14

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$661.19$147.23RVU26D
2026-07-01$661.19$147.23RVU26C
2026-04-01$661.19$147.23RVU26B
2026-01-01$661.19$147.23RVU26A
2025-10-01$560.29$158.34RVU25D
2025-07-01$560.29$158.34RVU25C
2025-04-01$560.29$158.34RVU25B
2025-01-01$560.29$158.34RVU25A
2024-10-01$593.67$162.60RVU24D
2024-07-01$593.67$162.60RVU24C
2024-04-01$593.67$162.60RVU24B
2024-03-09$593.67$162.60RVU24AR
2024-01-01$583.98$159.94RVU24A
2023-10-01$611.38$164.25RVU23D
2023-07-01$607.60$164.01RVU23C
2023-04-01$607.60$164.01RVU23B
2023-01-01$607.60$164.01RVU23A
2022-10-01$643.93$167.08RVU22D
2022-07-01$643.93$167.08RVU22C
2022-04-01$643.93$167.08RVU22B
2022-01-01$643.93$167.08RVU22A
2021-10-01$671.08$167.77RVU21D
2021-07-01$671.08$167.77RVU21C
2021-04-01$671.08$167.77RVU21B
2021-01-01$671.08$167.77RVU21A
2020-10-01$642.47$171.73RVU20D
2020-07-01$642.47$171.73RVU20C
2020-04-01$642.47$171.73RVU20B
2020-01-01$642.47$171.73RVU20A
2019-10-01$644.66$174.68RVU19D
2019-07-01$644.66$174.68RVU19C
2019-04-01$644.66$174.68RVU19B
2019-01-01$644.66$174.68RVU19A
2018-10-01$649.76$174.86RVU18D
2018-07-01$649.76$174.86RVU18C
2018-04-01$649.76$174.86RVU18B
2018-01-01$649.76$174.86RVU18AR1
2017-10-01$559.38$160.94RVU17D
2017-07-01$559.38$160.94RVU17C
2017-04-01$559.38$160.94RVU17B
2017-01-01$559.38$160.94RVU17A
2016-10-01$523.56$152.00RVU16D
2016-07-01$523.56$152.00RVU16C
2016-04-01$523.56$152.00RVU16B
2016-01-01$523.56$152.00RVU16A
2015-10-01$311.91$153.83RVU15D
2015-07-01$311.91$153.83RVU15C
2015-04-01$310.36$153.07RVU15B
2015-01-01$310.36$153.07RVU15A
2014-10-01$305.14$152.93RVU14D
2014-07-01$305.14$152.93RVU14C
2014-04-01$305.14$152.93RVU14B
2014-01-01$305.14$152.93RVU14A
2013-10-01Not available in this setting$177.70RVU13D
2013-07-01Not available in this setting$177.70RVU13C
2013-04-01Not available in this setting$177.70RVU13B
2013-01-01Not available in this setting$177.70RVU13AR

Price 43227 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 43227PPRRVU2026_Oct_nonQPP.csv, line 5,157 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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