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

Report this service when an upper endoscopy is used to ablate a tumor, polyp, or other upper-GI lesion rather than remove it conventionally.

CMS RVU26DEffective Oct 1, 2026One payment locality18.4K Medicare services in 2024

In Wisconsin, Medicare pays $764.85 for 43270 in the office and $185.36 when it’s performed in a hospital or facility.

$764.85Office (non-facility)
$185.36Hospital or facility
−4.7%vs the national office rate ($802.62)

Check a contract rate as a % of Medicare · 43270 nationwide

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

We’ll open 43270 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Wisconsin
  2. What 43270 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Wisconsin compares for 43270

Across 109 of 109 payment localities, the office rate for 43270 runs from $702.81 in Arkansas to $1,100.71 in San Benito County, CA. Wisconsin pays $764.85. The RVUs are the same everywhere; the geographic indexes change the dollars.

43270 in Wisconsin vs other payment areas
  1. Wisconsin · this page$764.85
  2. Los Angeles, CA · California$923.33+$158.48
  3. Washington, DC area · District of Columbia$928.34+$163.49
  4. Miami, FL · Florida$852.04+$87.19
  5. Chicago, IL · Illinois$825.86+$61.01
  6. Manhattan, NY · New York$926.08+$161.23
  7. Alaska · Alaska$904.05+$139.20

Other areas in Wisconsin first, then benchmark localities. Bars start at $0.

Every other payment area

43270 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$714.08$184.80
ArkansasArkansas$702.81$183.21
ArizonaArizona$780.13$193.99
Bakersfield, CACalifornia$862.46$199.50
Chico, CACalifornia$861.13$198.17
El Centro, CACalifornia$861.20$198.24
Fresno, CACalifornia$861.13$198.17
Hanford, CACalifornia$861.13$198.17

43270 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$702.81

$980.92

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
43270 office rate range by state
State / territoryOffice rate rangeLocalities
AK$904.051
AL$714.081
AR$702.811
AZ$780.131
CA$861.13–$1,100.7129
CO$843.041
CT$858.941
DC$928.341
DE$793.901
FL$781.09–$852.043
GA$734.45–$816.492
GU$886.491
HI$886.491
IA$737.891
ID$742.291
IL$753.71–$832.634
IN$747.081
KS$732.231
KY$728.411
LA$726.41–$765.842
MA$836.57–$933.882
MD$810.61–$928.343
ME$744.48–$791.282
MI$747.33–$789.702
MN$811.341
MO$711.53–$771.103
MS$707.421
MT$802.591
NC$753.281
ND$793.891
NE$742.871
NH$827.741
NJ$869.75–$917.022
NM$751.021
NV$800.831
NY$765.39–$947.815
OH$745.551
OK$729.011
OR$795.63–$873.912
PA$747.91–$834.762
PR$809.631
RI$825.211
SC$750.461
SD$792.871
TN$736.001
TX$742.42–$839.338
UT$761.681
VA$787.13–$928.342
VI$809.631
VT$788.791
WA$835.65–$955.682
WI$764.851
WV$722.851
WY$798.801

See 43270 in every payment locality

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

Office or facility?

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.

The exact Wisconsin inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,196

Code
43270
Physician work
3.91
Practice expense
19.68
Malpractice
0.44

GPCI2026.csv

111

Locality
Wisconsin
Physician work
1.000
Practice expense
0.958
Malpractice
0.308
Office calculation for 43270 in Wisconsin
ComponentRVULocality factorAdjusted
Physician work3.91× 1.0003.9100
Practice expense19.68× 0.95818.8534
Malpractice0.44× 0.3080.1355
Total RVUs22.8990
Conversion factor× 33.4009

Office rate, Wisconsin$764.85

Office: (3.91 × 1 + 19.68 × 0.958 + 0.44 × 0.308) × $33.4009 = $764.85

Facility: (3.91 × 1 + 1.57 × 0.958 + 0.44 × 0.308) × $33.4009 = $185.36

Open 43270 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 43270

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

Codes related to 43270
CodeHow it relatesOffice range, Wisconsin
Used instead
43254Endoscopic resection, mucosal resectionEndoscopic mucosal resection is an alternative when the upper-GI lesion is removed rather than ablated.No office rate
43278ERCP ablation, with dilation when performedUsed for ERCP-based ablation of a duct lesion, with duct or ampullary dilation when performed.No office rate
Often billed with
43255Bleeding control, any endoscopic hemostasis methodMay be relevant for a distinct bleeding source treated during the same session, subject to applicable edits.$656.52

How 43270 has changed in Wisconsin

43270 · Office / nonfacility

$764.85

Effective 2026-10-01

The base rate is $115.00 higher than on 2025-10-01, moving from $649.85 to $764.85 (17.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $649.85changed to$764.85

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.01 changed to 3.91
    • Practice expense RVU 16.63 changed to 19.68
    • Malpractice RVU 0.50 changed to 0.44
    • Practice expense GPCI 0.957 changed to 0.958
    • Malpractice GPCI 0.331 changed to 0.308

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $689.45changed to$649.85

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 17.29 changed to 16.63
    • Malpractice RVU 0.47 changed to 0.50

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $678.20changed to$689.45

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $705.77changed to$678.20

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 17.55 changed to 17.29
    • Malpractice RVU 0.46 changed to 0.47
    • Practice expense GPCI 0.950 changed to 0.957
    • Malpractice GPCI 0.314 changed to 0.331

  5. January 1, 2023

    RVU23A

    $738.43changed to$705.77

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 18.26 changed to 17.55
    • Malpractice RVU 0.43 changed to 0.46
    • Practice expense GPCI 0.942 changed to 0.950
    • Malpractice GPCI 0.296 changed to 0.314

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $743.02changed to$738.43

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 18.21 changed to 18.26
    • Malpractice RVU 0.44 changed to 0.43

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $694.39changed to$743.02

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 15.90 changed to 18.21
    • Practice expense GPCI 0.949 changed to 0.942
    • Malpractice GPCI 0.322 changed to 0.296

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $672.72changed to$694.39

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 15.13 changed to 15.90
    • Malpractice RVU 0.51 changed to 0.44
    • Practice expense GPCI 0.957 changed to 0.949
    • Malpractice GPCI 0.347 changed to 0.322

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $650.97changed to$672.72

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 14.52 changed to 15.13

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $646.16changed to$650.97

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 14.39 changed to 14.52
    • Malpractice RVU 0.52 changed to 0.51
    • Practice expense GPCI 0.956 changed to 0.957
    • Malpractice GPCI 0.457 changed to 0.347

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $728.54changed to$646.16

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 4.26 changed to 4.01
    • Practice expense RVU 16.52 changed to 14.39
    • Malpractice RVU 0.55 changed to 0.52
    • Practice expense GPCI 0.955 changed to 0.956
    • Malpractice GPCI 0.566 changed to 0.457

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $744.61changed to$728.54

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 16.87 changed to 16.52
    • Malpractice RVU 0.62 changed to 0.55

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $740.90changed to$744.61

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $703.30changed to$740.90

    • Conversion factor 35.8228 changed to 35.7547
    • Work RVU 4.21 changed to 4.26
    • Practice expense RVU 15.75 changed to 16.87
    • Malpractice RVU 0.60 changed to 0.62
    • Practice expense GPCI 0.958 changed to 0.955
    • Malpractice GPCI 0.557 changed to 0.566

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$703.30

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$764.85$185.36RVU26D
2026-07-01$764.85$185.36RVU26C
2026-04-01$764.85$185.36RVU26B
2026-01-01$764.85$185.36RVU26A
2025-10-01$649.85$201.31RVU25D
2025-07-01$649.85$201.31RVU25C
2025-04-01$649.85$201.31RVU25B
2025-01-01$649.85$201.31RVU25A
2024-10-01$689.45$206.51RVU24D
2024-07-01$689.45$206.51RVU24C
2024-04-01$689.45$206.51RVU24B
2024-03-09$689.45$206.51RVU24AR
2024-01-01$678.20$203.14RVU24A
2023-10-01$705.77$208.39RVU23D
2023-07-01$705.77$208.39RVU23C
2023-04-01$705.77$208.39RVU23B
2023-01-01$705.77$208.39RVU23A
2022-10-01$738.43$211.96RVU22D
2022-07-01$738.43$211.96RVU22C
2022-04-01$738.43$211.96RVU22B
2022-01-01$738.43$211.96RVU22A
2021-10-01$743.02$212.83RVU21D
2021-07-01$743.02$212.83RVU21C
2021-04-01$743.02$212.83RVU21B
2021-01-01$743.02$212.83RVU21A
2020-10-01$694.39$219.36RVU20D
2020-07-01$694.39$219.36RVU20C
2020-04-01$694.39$219.36RVU20B
2020-01-01$694.39$219.36RVU20A
2019-10-01$672.72$221.60RVU19D
2019-07-01$672.72$221.60RVU19C
2019-04-01$672.72$221.60RVU19B
2019-01-01$672.72$221.60RVU19A
2018-10-01$650.97$222.39RVU18D
2018-07-01$650.97$222.39RVU18C
2018-04-01$650.97$222.39RVU18B
2018-01-01$650.97$222.39RVU18AR1
2017-10-01$646.16$223.81RVU17D
2017-07-01$646.16$223.81RVU17C
2017-04-01$646.16$223.81RVU17B
2017-01-01$646.16$223.81RVU17A
2016-10-01$728.54$238.21RVU16D
2016-07-01$728.54$238.21RVU16C
2016-04-01$728.54$238.21RVU16B
2016-01-01$728.54$238.21RVU16A
2015-10-01$744.61$242.90RVU15D
2015-07-01$744.61$242.90RVU15C
2015-04-01$740.90$241.69RVU15B
2015-01-01$740.90$241.69RVU15A
2014-10-01$703.30$240.00RVU14D
2014-07-01$703.30$240.00RVU14C
2014-04-01$703.30$240.00RVU14B
2014-01-01$703.30$240.00RVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 43270 for an earlier date of service

Where the Wisconsin rate applies

Wisconsin is a Medicare payment area, not a city. Our Census mapping connects it to 807 cities and communities in Wisconsin. Some span more than one payment area; confirm with the service ZIP.

  • Abbotsford
  • Abrams
  • Adams
  • Adell
  • Albany
  • Algoma
  • Allens Grove
  • Allenton

Browse all communities in Wisconsin

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

Show the CMS file lines behind this rate
RVUs for 43270PPRRVU2026_Oct_nonQPP.csv, line 5,196 (RVU26D)
Geographic factors for WisconsinGPCI2026.csv, line 111 (RVU26D)

Open CMS sourceHow we calculate rates

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