CPT code 43255: Bleeding control, any endoscopic hemostasis method2026 Medicare rate & RVUs

Medicare pays $689.06 for 43255 nationally in the office and $177.02 in a hospital or facility. Local office rates run $603.76–$943.34.

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

What 43255 covers

A gastroenterologist or other qualified endoscopist uses an upper endoscope to treat a bleeding site in the esophagus, stomach, or duodenum. Examples include hemostasis of a bleeding peptic ulcer or a Dieulafoy lesion using clips, thermal treatment, or injection. The code represents an endoscopic attempt to control bleeding, not inspection alone; the procedure may occur during an urgent evaluation of hematemesis or upper gastrointestinal blood loss.

Report it when the endoscopist performs hemostasis and the record identifies the bleeding site, findings, and treatment method. Use the variceal injection or ligation codes when that specific variceal treatment is performed. Medicare 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. 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 43255 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

43255 rates by state

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

How the 43255 rate is calculated

Each of 43255’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.

Payment rules and modifiers for 43255

The CMS indicators that decide how 43255 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

43255 compared with similar codes

How to choose

43243Variceal injectionEsophageal or gastric varices

Choose 43243 when the endoscopist injects esophageal varices. This code describes other endoscopic bleeding control.

43244Variceal ligationEsophageal or gastric varices

Choose 43244 for ligation of esophageal varices; this code is for bleeding control by other endoscopic methods.

43250Upper endoscopyCautery lesion removal

43250 describes cautery treatment of a tumor or polyp. Choose this code when the documented service is hemostasis of a bleeding site.

43251EGD lesion removalSnare technique

43251 describes snare removal of a lesion. Choose this code when the endoscopic service is control of bleeding rather than lesion removal.

Codes related to 43255

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

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

Open CMS sourceHow we calculate rates