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Billing code 43204: Variceal injectionMedicare rate & RVUs

Flexible esophagoscopy with sclerosant injection treats esophageal varices through endoscopic delivery of therapy, including in patients with variceal bleeding.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $120.58 for 43204 nationally in a facility.

Medicare rate · 43204

Variceal injection

Swap in your local Medicare rate.

Work RVUs
2.27
Total RVUs
3.61
Global days
000

National rate · 2026

$120.58

Facility setting, before claim adjustments.

See every locality for 43204 → · Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 43204 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43204 covers

This service uses flexible transoral esophagoscopy to deliver a sclerosant to esophageal varices, with the goal of obliterating the treated vessels. Gastroenterologists and other physicians trained in therapeutic endoscopy perform it for esophageal varices, including in patients with portal-hypertension-related upper gastrointestinal bleeding. The procedure may take place in a hospital endoscopy unit or an ambulatory surgery setting. The target is the varix, not general medication injection into the esophageal wall.

Report 43204 when the record supports endoscopic variceal sclerotherapy, including the indication, findings, varices treated, and sclerosant delivery. Use 43201 for a different submucosal injection service, or 43205 when varices are treated by ligation. 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 governs payment. Modifier 50 is inappropriate for this esophageal service. Medicare assistant-at-surgery payment is barred; 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 43204 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

43204 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$112.40
Alaska*Unavailable$157.10
ArizonaUnavailable$118.25
ArkansasUnavailable$111.39
AtlantaUnavailable$123.07
AustinUnavailable$121.89
BakersfieldUnavailable$122.25
Baltimore/Surr. CntysUnavailable$126.43
BeaumontUnavailable$116.71
BrazoriaUnavailable$119.02

43204 rates by state

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

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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.

View every state and territory as a table
43204 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43204 rate is calculated

Each of 43204’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 · 43204

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 2.27Practice expense 1.09Malpractice 0.25

3.6100 adjusted RVUs×$33.4009 conversion factor=$120.58

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 43204

The CMS indicators that decide how 43204 is paid alongside other services.

CMS payment indicators · 43204

Variceal injection

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

43204 without 51 · national facility

$120.58

Variceal injection

43204-51 · Second procedure: 50%

$60.29

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

43204 compared with similar codes

Compare codes

43204 vs 43201 vs 43205 vs 43235: national Medicare rates

Swap in your local Medicare rate.

  • 43204
    Variceal injection · 2.27 wRVU
    —
  • 43201
    Esophagoscopy · 1.68 wRVU
    $278.23
  • 43205
    Variceal banding · 2.38 wRVU
    —
  • 43235
    Upper GI endoscopy · 2.04 wRVU
    $322.65

How to choose

43201Esophagoscopy
43204 is for sclerosant injection into esophageal varices; 43201 describes injection into the esophageal submucosa for another therapeutic purpose.
43205Variceal banding
Choose 43204 for variceal sclerotherapy and 43205 when the documented treatment is endoscopic ligation.
43235Upper GI endoscopy
43204 is therapeutic esophagoscopy for variceal sclerosis. 43235 describes diagnostic upper endoscopy with brushings or washings, not variceal injection.

Codes related to 43204

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

Codes related to 43204
CodeHow it relatesNational office range
Used instead
43201EsophagoscopyEsophageal submucosal injection for a therapeutic purpose other than variceal sclerosis.$244.38–$375.92
43205Variceal bandingEndoscopic variceal treatment by ligation rather than sclerosant injection.No office rate
43227EsophagoscopyEndoscopic bleeding control may be selected when the service is hemostasis rather than variceal sclerosis.$572.07–$902.81

43204 billing questions

When should I report 43204 instead of 43201?

Report 43204 for sclerosant injection directed at esophageal varices. Code 43201 describes a different injection service involving the esophageal submucosa.

How is 43204 different from variceal ligation?

43204 represents treatment by sclerosant injection. When the physician treats the varices by ligation, consider 43205 instead.

Can diagnostic esophagoscopy be separately reported with 43204?

Do not separately report a diagnostic esophagoscopy solely for inspection or access integral to the sclerotherapy session. The record should identify the therapeutic work performed.

Should modifier 50 be appended?

No. Modifier 50 is inappropriate for this esophageal service.

What documentation supports 43204?

Document the indication and endoscopic findings, identify the esophageal varices treated, and record the sclerosant injection 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

Show the CMS file lines behind this rate
RVUs for 43204PPRRVU2026_Oct_nonQPP.csv, line 5,143 (RVU26D)

Open CMS sourceHow we calculate rates

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