CPT code 43255: Bleeding control, any endoscopic hemostasis method2026 Medicare rate & RVUs in Barrington, Illinois
CPT 43255: $709.54–$715.05 office ($189.19–$194.95 facility) across 2 localities in Barrington, IL in 2026 Medicare. Compare each area.
Medicare pays $709.54–$715.05 for 43255 in the office in Barrington, Illinois, from Chicago, IL to Suburban Chicago, IL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 6 sections
Where 43255 pays more and less in Barrington, Illinois
Barrington, Illinois maps to 2 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $709.54 | $194.95 |
| Suburban Chicago, IL | $715.05 | $189.19 |
How payment areas work in Barrington
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- Chicago · Cook County
- Suburban Chicago · Lake County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
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.
How the rate is built · 43255
RVUs × geographic indexes × conversion factor
Work3.47
3.47 RVUs× 1.000 GPCI
Practice expense16.77
16.77 RVUs× 1.000 GPCI
Malpractice0.39
0.39 RVUs× 1.000 GPCI
Adjusted RVUs
20.6300
Conversion factor
$33.4009
Medicare rate
$689.06
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43255
The CMS indicators that decide how 43255 is paid alongside other services.
CMS payment indicators · 43255
Bleeding control, any endoscopic hemostasis method
| 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
43255 without 51 · national office
$689.06
Bleeding control, any endoscopic hemostasis method
43255-51 · Second procedure: 50%
$344.53
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%).
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
Fee sheets · Coming soon
Put 43255 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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