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Billing code 43257: GERD endoscopyMedicare rate & RVUs

Report this service when upper endoscopy is used to deliver thermal treatment at the gastroesophageal junction for gastroesophageal reflux disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities61 Medicare services in 2024

Medicare pays $204.41 for 43257 nationally in a facility.

Medicare rate · 43257

GERD endoscopy

Swap in your local Medicare rate.

Work RVUs
4.05
Total RVUs
6.12
Global days
000

National rate · 2026

$204.41

Facility setting, before claim adjustments.

See every locality for 43257 → · 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 43257 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 43257 covers

This service combines upper gastrointestinal endoscopy with thermal treatment directed at the gastroesophageal junction and lower esophageal sphincter to address GERD. A gastroenterologist typically performs it in an endoscopy suite or hospital outpatient setting, using an endoscopic device to deliver energy to the treatment area. It is not the code for a diagnostic examination alone or for treating a separate bleeding site or mucosal lesion.

Choose the code when the endoscopy and therapeutic thermal application are documented, including the GERD indication and treatment target. When related endoscopies are performed together, CMS endoscopy-family pricing applies. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate because this service is not a bilateral procedure. Assistant-at-surgery payment is statutorily restricted; 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 43257 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

43257 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$191.13
Alaska*Unavailable$268.82
ArizonaUnavailable$200.57
ArkansasUnavailable$189.49
AtlantaUnavailable$208.71
AustinUnavailable$206.11
BakersfieldUnavailable$206.30
Baltimore/Surr. CntysUnavailable$214.09
BeaumontUnavailable$198.48
BrazoriaUnavailable$201.70

43257 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.

View every state and territory as a table
43257 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 43257 rate is calculated

Each of 43257’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 · 43257

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 4.05Practice expense 1.62Malpractice 0.45

6.1200 adjusted RVUs×$33.4009 conversion factor=$204.41

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

Payment rules and modifiers for 43257

The CMS indicators that decide how 43257 is paid alongside other services.

CMS payment indicators · 43257

GERD 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

43257 without 51 · national facility

$204.41

GERD endoscopy

43257-51 · Second procedure: 50%

$102.21

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

43257 compared with similar codes

Compare codes

43257 vs 43235 vs 43270 vs 43255: national Medicare rates

Swap in your local Medicare rate.

  • 43257
    GERD endoscopy · 4.05 wRVU
    —
  • 43235
    Upper GI endoscopy · 2.04 wRVU
    $322.65
  • 43270
    Lesion ablation · 3.91 wRVU
    $802.62
  • 43255
    Bleeding control · 3.47 wRVU
    $689.06

How to choose

43235Upper GI endoscopy
Use 43257 when thermal treatment for GERD is delivered. Use 43235 for a diagnostic upper endoscopy without that therapeutic treatment.
43270Lesion ablation
43270 treats an endoscopically identified lesion with ablation. 43257 is for thermal treatment directed at GERD, not a focal lesion.
43255Bleeding control
43255 is reported for endoscopic control of bleeding. 43257 describes thermal treatment for GERD, not hemostasis.

Codes related to 43257

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

Codes related to 43257
CodeHow it relatesNational office range
Used instead
43235Upper GI endoscopyDiagnostic upper endoscopy when no GERD-directed thermal treatment is performed.$284.01–$435.38
43270Lesion ablationEndoscopic ablation directed at a lesion rather than GERD treatment.$702.81–$1,100.71
43255Bleeding controlEndoscopic treatment to control bleeding, not thermal treatment for reflux.$603.76–$943.34
43245EGD dilationEndoscopic dilation for a stricture rather than GERD-directed thermal treatment.$571.94–$898.52

43257 billing questions

When should this be reported instead of a diagnostic EGD?

Report 43257 when thermal treatment for GERD is actually performed during the endoscopy. A diagnostic examination without that treatment is represented by 43235.

Can the diagnostic EGD be reported separately in the same session?

The examination that supports the therapeutic procedure is integral to the service; do not separately report a diagnostic EGD for that same examination.

How are related endoscopies priced when performed together?

CMS endoscopy-family pricing applies when related endoscopies are performed together. Document each procedure performed and its treatment target.

Which modifiers are appropriate for bilateral treatment or multiple surgeons?

Modifier 50 is inappropriate for this service. CMS restricts assistant-at-surgery payment, and co-surgeons and team surgery are not permitted.

What documentation supports reporting 43257?

Document GERD as the indication, the endoscopic treatment site, and that thermal energy was delivered for reflux treatment—not merely that the area was examined.

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 43257PPRRVU2026_Oct_nonQPP.csv, line 5,185 (RVU26D)

Open CMS sourceHow we calculate rates

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