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

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 Virginia, Medicare pays $642.46 for 43227 in the office and $142.74 when it’s performed in a hospital or facility.

$642.46Office (non-facility)
$142.74Hospital or facility
−2.0%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 Virginia
  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 Virginia 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. Virginia pays $642.46. The RVUs are the same everywhere; the geographic indexes change the dollars.

43227 in Virginia vs other payment areas
  1. Virginia · this page$642.46
  2. Los Angeles, CA · California$755.63+$113.17
  3. Washington, DC area · District of Columbia$759.51+$117.05
  4. Miami, FL · Florida$696.22+$53.76
  5. Chicago, IL · Illinois$674.30+$31.84
  6. Manhattan, NY · New York$757.36+$114.90
  7. Alaska · Alaska$732.71+$90.25

Other areas in Virginia 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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 43227 in Virginia
ComponentRVULocality factorAdjusted
Physician work2.82× 1.0002.8200
Practice expense16.44× 0.98316.1605
Malpractice0.36× 0.7060.2542
Total RVUs19.2347
Conversion factor× 33.4009

Office rate, Virginia$642.46

Office: (2.82 × 1 + 16.44 × 0.983 + 0.36 × 0.706) × $33.4009 = $642.46

Facility: (2.82 × 1 + 1.22 × 0.983 + 0.36 × 0.706) × $33.4009 = $142.74

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, Virginia
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.$766.76

How 43227 has changed in Virginia

43227 · Office / nonfacility

$642.46

Effective 2026-10-01

The base rate is $95.03 higher than on 2025-10-01, moving from $547.43 to $642.46 (17.4%).

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

    $547.43changed to$642.46

    • 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
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $579.98changed to$547.43

    • 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

    $570.52changed to$579.98

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $600.50changed to$570.52

    • 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
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $636.02changed to$600.50

    • 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 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $662.85changed to$636.02

    • 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.

  7. January 1, 2021

    RVU21A

    $632.60changed to$662.85

    • 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
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $632.52changed to$632.60

    • 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 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $637.54changed to$632.52

    • 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.

  10. January 1, 2018

    RVU18AR1

    $629.83changed to$637.54

    • 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 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $693.90changed to$629.83

    • 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 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $399.40changed to$693.90

    • 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.

  13. July 1, 2015

    RVU15C

    $397.42changed to$399.40

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $393.63changed to$397.42

    • 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 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$393.63

    Held through RVU14B, RVU14C, RVU14D.

  16. 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$642.46$142.74RVU26D
2026-07-01$642.46$142.74RVU26C
2026-04-01$642.46$142.74RVU26B
2026-01-01$642.46$142.74RVU26A
2025-10-01$547.43$154.66RVU25D
2025-07-01$547.43$154.66RVU25C
2025-04-01$547.43$154.66RVU25B
2025-01-01$547.43$154.66RVU25A
2024-10-01$579.98$158.76RVU24D
2024-07-01$579.98$158.76RVU24C
2024-04-01$579.98$158.76RVU24B
2024-03-09$579.98$158.76RVU24AR
2024-01-01$570.52$156.16RVU24A
2023-10-01$600.50$161.35RVU23D
2023-07-01$600.50$161.35RVU23C
2023-04-01$600.50$161.35RVU23B
2023-01-01$600.50$161.35RVU23A
2022-10-01$636.02$165.31RVU22D
2022-07-01$636.02$165.31RVU22C
2022-04-01$636.02$165.31RVU22B
2022-01-01$636.02$165.31RVU22A
2021-10-01$662.85$166.03RVU21D
2021-07-01$662.85$166.03RVU21C
2021-04-01$662.85$166.03RVU21B
2021-01-01$662.85$166.03RVU21A
2020-10-01$632.60$169.81RVU20D
2020-07-01$632.60$169.81RVU20C
2020-04-01$632.60$169.81RVU20B
2020-01-01$632.60$169.81RVU20A
2019-10-01$632.52$172.35RVU19D
2019-07-01$632.52$172.35RVU19C
2019-04-01$632.52$172.35RVU19B
2019-01-01$632.52$172.35RVU19A
2018-10-01$637.54$172.54RVU18D
2018-07-01$637.54$172.54RVU18C
2018-04-01$637.54$172.54RVU18B
2018-01-01$637.54$172.54RVU18AR1
2017-10-01$629.83$171.34RVU17D
2017-07-01$629.83$171.34RVU17C
2017-04-01$629.83$171.34RVU17B
2017-01-01$629.83$171.34RVU17A
2016-10-01$693.90$175.82RVU16D
2016-07-01$693.90$175.82RVU16C
2016-04-01$693.90$175.82RVU16B
2016-01-01$693.90$175.82RVU16A
2015-10-01$399.40$178.99RVU15D
2015-07-01$399.40$178.99RVU15C
2015-04-01$397.42$178.10RVU15B
2015-01-01$397.42$178.10RVU15A
2014-10-01$393.63$178.07RVU14D
2014-07-01$393.63$178.07RVU14C
2014-04-01$393.63$178.07RVU14B
2014-01-01$393.63$178.07RVU14A
2013-10-01Not available in this setting$209.03RVU13D
2013-07-01Not available in this setting$209.03RVU13C
2013-04-01Not available in this setting$209.03RVU13B
2013-01-01Not available in this setting$209.03RVU13AR

Price 43227 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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