CPT code 43270: Lesion ablation, upper GI endoscopy2026 Medicare rate & RVUs in Louisiana
Report this service when an upper endoscopy is used to ablate a tumor, polyp, or other upper-GI lesion rather than remove it conventionally.
Medicare pays $726.41–$765.84 for 43270 in the office in Louisiana, from Rest of Louisiana to New Orleans, LA. 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.
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On this page 9 sections
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 in Louisiana
| Payment locality | Office | Facility |
|---|---|---|
| New Orleans, LA | $765.84 | $196.64 |
| Rest of Louisiana | $726.41 | $191.09 |
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.
How the rate is built · 43270
RVUs × geographic indexes × conversion factor
Work3.91
3.91 RVUs× 1.000 GPCI
Practice expense19.68
19.68 RVUs× 1.000 GPCI
Malpractice0.44
0.44 RVUs× 1.000 GPCI
Adjusted RVUs
24.0300
Conversion factor
$33.4009
Medicare rate
$802.62
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43270
The CMS indicators that decide how 43270 is paid alongside other services.
CMS payment indicators · 43270
Lesion ablation, upper GI endoscopy
| 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
43270 without 51 · national office
$802.62
Lesion ablation, upper GI endoscopy
43270-51 · Second procedure: 50%
$401.31
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%).
43270 compared with similar codes
Compare codes · National
5 codes, side by side
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.
43270 billing questions
When should this be reported instead of 43254?
Report 43270 for ablation of an upper-GI lesion. Use 43254 when the physician removes a lesion by endoscopic mucosal resection.
Can diagnostic inspection of the upper GI tract be billed separately?
The endoscopic inspection used to locate and treat the lesion is part of the therapeutic service. Do not report a separate diagnostic endoscopy for that same inspection.
Should modifier 50 be appended for lesions on both sides?
No. Modifier 50 is inappropriate for this upper-GI endoscopic service.
What documentation supports reporting this service?
Document the lesion’s location and nature, the ablation method, and why ablation was selected rather than conventional removal.
Are assistant or co-surgeon modifiers payable?
CMS does not pay for an assistant at surgery for this code. Co-surgeon and team-surgery reporting are not permitted.
How does CMS price this with another endoscopy in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together; the services are priced under that family rule.
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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