CPT code 43243: Variceal injection, esophageal or gastric varices2026 Medicare rate & RVUs in Guam
Upper endoscopy with injection therapy for esophageal or gastric varices, reported when the endoscopist treats varices by injecting a sclerosing agent.
CMS doesn’t publish an office rate for 43243 in Guam.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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.
43243 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $208.82 |
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
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
| 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
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%).
43243 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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