CPT code 43257: GERD endoscopy, thermal treatment2026 Medicare rate & RVUs in Illinois
Report this service when upper endoscopy is used to deliver thermal treatment at the gastroesophageal junction for gastroesophageal reflux disease.
CMS doesn’t publish an office rate for 43257 in Illinois.
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 43257 covers
This service combines upper gastrointestinal endoscopy with thermal treatment directed at the gastroesophageal junction and lower esophageal sphincter to address GERD. A gastroenterologist typically performs it in an endoscopy suite or hospital outpatient setting, using an endoscopic device to deliver energy to the treatment area. It is not the code for a diagnostic examination alone or for treating a separate bleeding site or mucosal lesion.
Choose the code when the endoscopy and therapeutic thermal application are documented, including the GERD indication and treatment target. When related endoscopies are performed together, CMS endoscopy-family pricing applies. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate because this service is not a bilateral procedure. Assistant-at-surgery payment is statutorily restricted; 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 43257 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | $225.10 |
| East St. Louis, IL | Unavailable | $215.33 |
| Rest of Illinois | Unavailable | $208.17 |
| Suburban Chicago, IL | Unavailable | $218.42 |
How the 43257 rate is calculated
Each of 43257’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 · 43257
RVUs × geographic indexes × conversion factor
Work4.05
4.05 RVUs× 1.000 GPCI
Practice expense1.62
1.62 RVUs× 1.000 GPCI
Malpractice0.45
0.45 RVUs× 1.000 GPCI
Adjusted RVUs
6.1200
Conversion factor
$33.4009
Medicare rate
$204.41
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43257
The CMS indicators that decide how 43257 is paid alongside other services.
CMS payment indicators · 43257
GERD endoscopy, thermal treatment
| 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
43257 without 51 · national facility
$204.41
GERD endoscopy, thermal treatment
43257-51 · Second procedure: 50%
$102.21
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%).
43257 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43235Upper GI endoscopyDiagnostic, brushings or washings
- Use 43257 when thermal treatment for GERD is delivered. Use 43235 for a diagnostic upper endoscopy without that therapeutic treatment.
- 43270Lesion ablationUpper GI endoscopy
- 43270 treats an endoscopically identified lesion with ablation. 43257 is for thermal treatment directed at GERD, not a focal lesion.
- 43255Bleeding controlAny endoscopic hemostasis method
- 43255 is reported for endoscopic control of bleeding. 43257 describes thermal treatment for GERD, not hemostasis.
43257 billing questions
When should this be reported instead of a diagnostic EGD?
Report 43257 when thermal treatment for GERD is actually performed during the endoscopy. A diagnostic examination without that treatment is represented by 43235.
Can the diagnostic EGD be reported separately in the same session?
The examination that supports the therapeutic procedure is integral to the service; do not separately report a diagnostic EGD for that same examination.
How are related endoscopies priced when performed together?
CMS endoscopy-family pricing applies when related endoscopies are performed together. Document each procedure performed and its treatment target.
Which modifiers are appropriate for bilateral treatment or multiple surgeons?
Modifier 50 is inappropriate for this service. CMS restricts assistant-at-surgery payment, and co-surgeons and team surgery are not permitted.
What documentation supports reporting 43257?
Document GERD as the indication, the endoscopic treatment site, and that thermal energy was delivered for reflux treatment—not merely that the area was examined.
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
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