CPT code 43270: Lesion ablation, upper GI endoscopy2026 Medicare rate & RVUs

Medicare pays $802.62 for 43270 nationally in the office and $197.73 in a hospital or facility. Local office rates run $702.81–$1,100.71.

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

What 43270 covers

During an upper endoscopy, a gastroenterologist or other qualified physician applies an ablative method to a tumor, polyp, or other lesion in the upper gastrointestinal tract. Examples include radiofrequency ablation of Barrett’s esophagus with dysplasia and argon plasma coagulation of selected mucosal lesions. The service is performed in settings equipped for therapeutic endoscopy, including hospital outpatient departments and ambulatory surgery centers.

Select this service when the lesion is treated by ablation rather than removed with a snare, hot biopsy forceps, or bipolar cautery. The report should identify the lesion’s location, the ablation performed, and the clinical reason for choosing ablation. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate for this upper-GI service. CMS does not pay for an assistant at surgery, and co-surgeon and team-surgery reporting 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 43270 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

43270 rates by state

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

How the 43270 rate is calculated

Each of 43270’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 43270

The CMS indicators that decide how 43270 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

43270 compared with similar codes

How to choose

43254Endoscopic resectionMucosal resection

43254 describes endoscopic mucosal resection. Choose 43270 when the lesion is ablated rather than resected.

43255Bleeding controlAny endoscopic hemostasis method

43255 is for endoscopic control of bleeding. Use 43270 for lesion ablation, not merely to treat hemorrhage.

43257GERD endoscopyThermal treatment

43257 describes thermal treatment directed at GERD. 43270 addresses ablation of an upper-GI tumor, polyp, or other lesion.

43278ERCP ablationWith dilation when performed

43278 is an ERCP service for ablation of a biliary or pancreatic duct lesion, with dilation when performed; 43270 is for upper-GI endoscopy.

Codes related to 43270

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