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CPT code 43243: Variceal injection, esophageal or gastric varices2026 Medicare rate & RVUs

Upper endoscopy with injection therapy for esophageal or gastric varices, reported when the endoscopist treats varices by injecting a sclerosing agent.

CMS RVU26DEffective Oct 1, 2026109 payment localities251 Medicare services in 2024

Medicare pays $209.09 for 43243 nationally in a facility.

Medicare rate · 43243

Variceal injection, esophageal or gastric varices

Office or facility?

Work RVUs
4.16
Total RVUs
6.26
Global days
000

National rate · 2026

$209.09

Facility setting, before claim adjustments.

See every locality for 43243 →Billed by an NP, PA or therapist? →

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

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 43243 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43243 covers

A gastroenterologist or other qualified endoscopist uses an upper endoscope to locate esophageal or gastric varices and injects them with a sclerosing agent. This treatment may be performed for varices associated with portal hypertension, including when variceal bleeding requires endoscopic intervention. The procedure is typically done in a hospital endoscopy suite or another setting equipped for upper endoscopy and patient monitoring.

Report this code when the documented endoscopic treatment is injection of varices, rather than band ligation or injection of a nonvariceal site. The procedure note should identify the varices treated and describe the injection therapy. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. CMS does not pay for an assistant at surgery; 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 43243 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43243 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$194.85
AlaskaUnavailable$274.02
ArizonaUnavailable$204.91
ArkansasUnavailable$193.11
Atlanta, GAUnavailable$213.90
Austin, TXUnavailable$210.39
Bakersfield, CAUnavailable$209.84
Baltimore area, MDUnavailable$219.34
Beaumont, TXUnavailable$203.11
Brazoria, TXUnavailable$205.83

43243 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.

View every state and territory as a table
43243 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43243 rate is calculated

Each of 43243’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 · 43243

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.16

4.16 RVUs× 1.000 GPCI

Practice expense1.57

1.57 RVUs× 1.000 GPCI

Malpractice0.53

0.53 RVUs× 1.000 GPCI

Adjusted RVUs

6.2600

Conversion factor

$33.4009

Medicare rate

$209.09

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 43243

The CMS indicators that decide how 43243 is paid alongside other services.

CMS payment indicators · 43243

Variceal injection, esophageal or gastric varices

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

43243 without 51 · national facility

$209.09

Variceal injection, esophageal or gastric varices

43243-51 · Second procedure: 50%

$104.55

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

43243 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43243

    Variceal injection, esophageal or gastric varices4.16 wRVU

    Not priced

  • 43244

    Variceal ligation, esophageal or gastric varices4.29 wRVU

    Not priced

  • 43236

    Submucosal injection, directed injection2.33 wRVU

    $446.24

  • 43255

    Bleeding control, any endoscopic hemostasis method3.47 wRVU

    $689.06

How to choose

43244Variceal ligationEsophageal or gastric varices
43243 describes injection treatment of varices; 43244 describes treatment by band ligation.
43236Submucosal injectionDirected injection
43236 is for upper-GI submucosal injection at a nonvariceal target. Use 43243 when the injection treats esophageal or gastric varices.
43255Bleeding controlAny endoscopic hemostasis method
43255 is for endoscopic control of bleeding. Choose 43243 when the documented treatment is injection therapy directed at varices.

Codes related to 43243

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

Codes related to 43243
CodeHow it relatesNational office range
Used instead
43244Variceal ligation, esophageal or gastric varicesTreats varices by band ligation rather than injection.No office rate
43255Bleeding control, any endoscopic hemostasis methodEndoscopic hemostasis code when bleeding control, rather than variceal injection, is performed.$603.76–$943.34
Same family
43236Submucosal injection, directed injectionRelated therapeutic EGD injection code for a nonvariceal target.$391.19–$609.46

43243 billing questions

How does this differ from variceal band ligation?

Use 43243 for injection treatment of varices. Use 43244 when the endoscopist treats them by applying bands.

Is injection of a nonvariceal lesion reported with this code?

No. Code 43243 is specific to injection treatment of varices; code 43236 describes a different upper-GI injection service.

Can the diagnostic EGD be reported separately?

The diagnostic examination performed as part of the variceal treatment is not a separate diagnostic service. Report the therapeutic service performed.

Should modifier 50 be appended for varices on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code.

Can an assistant or co-surgeon be reported?

CMS does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

What happens when another related endoscopy is performed at the same session?

CMS endoscopy family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included in the 0-day global period.

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 43243PPRRVU2026_Oct_nonQPP.csv, line 5,171 (RVU26D)

Open CMS sourceHow we calculate rates

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