Billing code 43227: EsophagoscopyMedicare rate & RVUs
Flexible transoral esophagoscopy with endoscopic hemostasis is reported when active esophageal bleeding is treated during the procedure, rather than merely evaluated.
Medicare pays $655.33 for 43227 nationally in the office and $146.96 in a hospital or facility. Local office rates run $572.07–$902.81.
Medicare rate · 43227
Esophagoscopy
- Work RVUs
- 2.82
- Total RVUs
- 19.62
- Global days
- 000
National rate · 2026
$655.33
Office setting, before claim adjustments.
See every locality for 43227 →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
What 43227 covers
A flexible scope is passed through the mouth to inspect the esophagus and treat a bleeding site under direct visualization. Gastroenterologists commonly perform this service in a hospital or ambulatory endoscopy setting for active bleeding from esophageal mucosa or a lesion. Hemostasis may use an endoscopic technique such as injection, thermal treatment, or clips, depending on the source and clinical circumstances.
Report the service when the procedure includes treatment to control esophageal bleeding, not inspection alone. The operative report should identify the bleeding source and describe the hemostatic treatment. When related endoscopies are performed together, CMS endoscopy-family pricing applies. The 0-day global period includes same-day preoperative and postoperative care. The esophagus is not reported bilaterally, so modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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 43227 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$572.07 to $902.81
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $581.47 | $136.65 |
| Alaska* | $732.71 | $191.31 |
| Arizona | $636.57 | $143.97 |
| Arkansas | $572.07 | $135.39 |
| Atlanta | $666.81 | $150.32 |
| Austin | $685.99 | $148.15 |
| Bakersfield | $705.13 | $147.96 |
| Baltimore/Surr. Cntys | $699.77 | $154.30 |
| Beaumont | $605.05 | $142.44 |
| Brazoria | $648.49 | $144.71 |
| Chicago | $674.30 | $163.40 |
| Chico | $704.06 | $146.90 |
| Colorado | $688.97 | $148.07 |
| Connecticut | $702.02 | $154.51 |
| Dallas | $652.27 | $145.94 |
| Dc + Md/Va Suburbs | $759.51 | $160.66 |
| Delaware | $647.99 | $145.73 |
| Detroit | $644.36 | $153.79 |
| East St. Louis | $623.59 | $155.90 |
| El Centro | $704.12 | $146.96 |
| Fort Lauderdale | $672.18 | $157.21 |
| Fort Worth | $646.93 | $145.69 |
| Fresno | $704.06 | $146.90 |
| Galveston | $650.17 | $145.36 |
| Hanford-Corcoran | $704.06 | $146.90 |
| Hawaii, Guam | $725.49 | $147.48 |
| Houston | $656.76 | $151.95 |
| Idaho | $605.06 | $137.37 |
| Indiana | $609.06 | $137.81 |
| Iowa | $601.40 | $136.25 |
| Kansas | $596.65 | $137.09 |
| Kentucky | $593.35 | $141.42 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $755.63 | $154.24 |
| Madera | $704.06 | $146.90 |
| Manhattan | $757.36 | $166.64 |
| Merced | $704.06 | $146.90 |
| Metropolitan Boston | $764.39 | $157.41 |
| Metropolitan Kansas City | $621.55 | $144.20 |
| Metropolitan Philadelphia | $681.86 | $152.65 |
| Metropolitan St. Louis | $628.99 | $145.03 |
| Miami | $696.22 | $167.02 |
| Minnesota | $662.78 | $139.68 |
| Mississippi | $575.86 | $138.16 |
| Modesto | $704.06 | $146.90 |
| Montana** | $655.30 | $146.94 |
| Napa | $829.96 | $159.94 |
| Nebraska | $605.56 | $136.35 |
| Nevada** | $653.87 | $145.00 |
| New Hampshire | $676.34 | $147.13 |
| New Mexico | $612.17 | $146.00 |
| New Orleans | $624.56 | $146.20 |
| North Carolina | $614.19 | $139.89 |
| North Dakota** | $648.18 | $139.82 |
| Northern Nj | $749.94 | $160.24 |
| Nyc Suburbs/Long Island | $775.44 | $171.00 |
| Ohio | $607.65 | $143.51 |
| Oklahoma | $593.89 | $139.92 |
| Oxnard-Thousand Oaks-Ventura | $753.37 | $152.48 |
| Portland | $714.71 | $149.92 |
| Poughkpsie/N Nyc Suburbs | $714.25 | $157.60 |
| Puerto Rico | $661.19 | $147.23 |
| Queens | $766.61 | $165.72 |
| Redding | $704.06 | $146.90 |
| Rest Of California | $704.06 | $146.90 |
| Rest Of Florida | $637.21 | $151.22 |
| Rest Of Georgia | $598.33 | $144.87 |
| Rest Of Illinois | $614.32 | $150.19 |
| Rest Of Louisiana | $591.67 | $141.77 |
| Rest Of Maine | $606.85 | $139.16 |
| Rest Of Maryland | $661.87 | $147.41 |
| Rest Of Massachusetts | $683.49 | $148.19 |
| Rest Of Michigan | $609.10 | $144.97 |
| Rest Of Missouri | $579.24 | $141.03 |
| Rest Of New Jersey | $710.78 | $155.65 |
| Rest Of New York | $624.30 | $141.36 |
| Rest Of Oregon | $649.56 | $143.23 |
| Rest Of Pennsylvania | $609.64 | $142.96 |
| Rest Of Texas | $626.15 | $143.72 |
| Rest Of Washington | $682.78 | $147.47 |
| Rhode Island | $673.94 | $148.80 |
| Riverside-San Bernardino-Ontario | $707.97 | $150.80 |
| Sacramento-Roseville-Folsom | $742.64 | $151.42 |
| Salinas | $739.97 | $150.78 |
| San Diego-Chula Vista-Carlsbad | $760.27 | $152.27 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $882.90 | $166.11 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $882.50 | $165.71 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $902.81 | $169.76 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $901.14 | $168.09 |
| San Luis Obispo-Paso Robles | $727.67 | $148.65 |
| Santa Cruz-Watsonville | $769.78 | $152.12 |
| Santa Maria-Santa Barbara | $743.54 | $150.79 |
| Santa Rosa-Petaluma | $777.77 | $153.50 |
| Seattle (King Cnty) | $782.48 | $158.72 |
| South Carolina | $611.79 | $142.06 |
| South Dakota** | $647.34 | $138.98 |
| Southern Maine | $645.95 | $142.16 |
| Stockton | $704.06 | $146.90 |
| Suburban Chicago | $680.09 | $158.01 |
| Tennessee | $599.79 | $137.69 |
| Utah | $621.15 | $143.29 |
| Vallejo | $829.37 | $159.35 |
| Vermont | $643.89 | $140.62 |
| Virgin Islands | $661.19 | $147.23 |
| Virginia | $642.46 | $142.74 |
| Visalia | $704.06 | $146.90 |
| West Virginia | $588.57 | $146.81 |
| Wisconsin | $623.94 | $136.93 |
| Wyoming** | $652.20 | $143.84 |
| Yuba City | $704.06 | $146.90 |
43227 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$572.07
$803.44
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $732.71 | 1 |
| AL | $581.47 | 1 |
| AR | $572.07 | 1 |
| AZ | $636.57 | 1 |
| CA | $704.06–$902.81 | 29 |
| CO | $688.97 | 1 |
| CT | $702.02 | 1 |
| DC | $759.51 | 1 |
| DE | $647.99 | 1 |
| FL | $637.21–$696.22 | 3 |
| GA | $598.33–$666.81 | 2 |
| GU | $725.49 | 1 |
| HI | $725.49 | 1 |
| IA | $601.40 | 1 |
| ID | $605.06 | 1 |
| IL | $614.32–$680.09 | 4 |
| IN | $609.06 | 1 |
| KS | $596.65 | 1 |
| KY | $593.35 | 1 |
| LA | $591.67–$624.56 | 2 |
| MA | $683.49–$764.39 | 2 |
| MD | $661.87–$759.51 | 3 |
| ME | $606.85–$645.95 | 2 |
| MI | $609.10–$644.36 | 2 |
| MN | $662.78 | 1 |
| MO | $579.24–$628.99 | 3 |
| MS | $575.86 | 1 |
| MT | $655.30 | 1 |
| NC | $614.19 | 1 |
| ND | $648.18 | 1 |
| NE | $605.56 | 1 |
| NH | $676.34 | 1 |
| NJ | $710.78–$749.94 | 2 |
| NM | $612.17 | 1 |
| NV | $653.87 | 1 |
| NY | $624.30–$775.44 | 5 |
| OH | $607.65 | 1 |
| OK | $593.89 | 1 |
| OR | $649.56–$714.71 | 2 |
| PA | $609.64–$681.86 | 2 |
| PR | $661.19 | 1 |
| RI | $673.94 | 1 |
| SC | $611.79 | 1 |
| SD | $647.34 | 1 |
| TN | $599.79 | 1 |
| TX | $605.05–$685.99 | 8 |
| UT | $621.15 | 1 |
| VA | $642.46–$759.51 | 2 |
| VI | $661.19 | 1 |
| VT | $643.89 | 1 |
| WA | $682.78–$782.48 | 2 |
| WI | $623.94 | 1 |
| WV | $588.57 | 1 |
| WY | $652.20 | 1 |
How the 43227 rate is calculated
Each of 43227’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 · 43227
RVUs × geographic indexes × conversion factor
Work2.82
2.82 RVUs× 1.000 GPCI
Practice expense16.44
16.44 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
19.6200
Conversion factor
$33.4009
Medicare rate
$655.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43227
The CMS indicators that decide how 43227 is paid alongside other services.
CMS payment indicators · 43227
Esophagoscopy
| 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
43227 without 51 · national office
$655.33
Esophagoscopy
43227-51 · Second procedure: 50%
$327.67
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%).
43227 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43243Variceal injection
- 43243 describes injection treatment of varices during upper endoscopy. Use 43227 for esophagoscopy with bleeding control when the procedure is not the variceal-injection service.
- 43244Variceal ligation
- 43244 describes variceal ligation during upper endoscopy. 43227 is the esophagoscopy service for endoscopic bleeding control.
- 43229Esophageal ablation
- 43229 is for ablation of an esophageal lesion. Choose 43227 when the documented service is controlling bleeding rather than ablating a lesion as the treatment objective.
- 43235Upper GI endoscopy
- 43235 is a diagnostic upper endoscopy service. 43227 requires esophagoscopy with treatment to control bleeding.
43227 billing questions
When should 43227 be chosen over a diagnostic esophagoscopy?
Use 43227 when the esophagoscopy includes endoscopic treatment to control bleeding. Inspection without hemostasis is not this service.
How does 43227 differ from variceal injection or ligation?
43227 represents esophagoscopy with bleeding control. Codes 43243 and 43244 describe variceal treatment performed with upper endoscopy; choose based on the procedure actually performed.
What documentation supports reporting 43227?
Document the esophageal bleeding source and the method used to achieve hemostasis. The record should show treatment of bleeding, rather than observation alone.
Is same-day care included in the payment?
Yes. The 0-day global period includes preoperative and postoperative care on the procedure date.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 43227. Co-surgeons and team surgery are not permitted.
How are related endoscopies handled when performed together?
CMS endoscopy-family pricing applies when related endoscopies are performed together, so payment reflects the family-pricing rules.
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
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