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CMS RVU26D · Effective 2026-10-01

43255 in Chico

Office / nonfacility

$738.76

Base rate per service

Facility setting

$177.57

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Gastrointestinal endoscopy

About 43255: Upper endoscopy with bleeding control

Reports upper endoscopic treatment to stop gastrointestinal bleeding, such as bleeding from an ulcer or other nonvariceal lesion.

A gastroenterologist or other qualified endoscopist uses an upper endoscope to treat a bleeding site in the esophagus, stomach, or duodenum. Examples include hemostasis of a bleeding peptic ulcer or a Dieulafoy lesion using clips, thermal treatment, or injection. The code represents an endoscopic attempt to control bleeding, not inspection alone; the procedure may occur during an urgent evaluation of hematemesis or upper gastrointestinal blood loss.

Report it when the endoscopist performs hemostasis and the record identifies the bleeding site, findings, and treatment method. Use the variceal injection or ligation codes when that specific variceal treatment is performed. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.

CMS billing rules for 43255

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
Multiple procedures
Endoscopy family pricing applies when related endoscopies are performed together.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU3.47 · 17%
  • Practice expense (office) RVU16.77 · 81%
  • Malpractice RVU0.39 · 2%

53.5K

Medicare services in 2024 · #756 by national volume

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.

43255 compared with similar codes

Office rates for Chico, from the same CMS release.

43243

Variceal injection

Esophageal or gastric varices

No office rate

Choose 43243 when the endoscopist injects esophageal varices. This code describes other endoscopic bleeding control.

43244

Variceal ligation

Esophageal or gastric varices

No office rate

Choose 43244 for ligation of esophageal varices; this code is for bleeding control by other endoscopic methods.

43250

Upper endoscopy

Cautery lesion removal

$531.04

43250 describes cautery treatment of a tumor or polyp. Choose this code when the documented service is hemostasis of a bleeding site.

43251

EGD lesion removal

Snare technique

$581.95

43251 describes snare removal of a lesion. Choose this code when the endoscopic service is control of bleeding rather than lesion removal.

The same code, a different location

How does Chico compare?

In Bakersfield, the office rate for 43255 is $739.94—$1.18 higher than the $738.76 rate in Chico. Both use the same code, release and participation basis.

43255 across payment areas

Same release and payment basis · bars start at $0

  1. Chico · This locality

    $738.76

  2. Bakersfield

    $739.94

    $1.18 higher than Chico

  3. El Centro

    $738.82

    $0.06 higher than Chico

  4. Fresno

    $738.76

    The same base rate than Chico

  5. Hanford-Corcoran

    $738.76

    The same base rate than Chico

  6. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $791.94

    $53.18 higher than Chico

  7. Madera

    $738.76

    The same base rate than Chico

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 43255 ranges from $603.76 in Arkansas to $943.34 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Merced

    California · 43255

    Office

    $738.76

    Facility

    $177.57

    The same base rate than Chico for the office setting.

  • Modesto

    California · 43255

    Office

    $738.76

    Facility

    $177.57

    The same base rate than Chico for the office setting.

  • Napa

    California · 43255

    Office

    $868.08

    Facility

    $193.21

    $129.32 higher than Chico for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 43255

    Office

    $789.34

    Facility

    $184.11

    $50.58 higher than Chico for the office setting.

  • Redding

    California · 43255

    Office

    $738.76

    Facility

    $177.57

    The same base rate than Chico for the office setting.

  • Rest Of California

    California · 43255

    Office

    $738.76

    Facility

    $177.57

    The same base rate than Chico for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 43255

    Office

    $743.00

    Facility

    $181.81

    $4.24 higher than Chico for the office setting.

  • Sacramento-Roseville-Folsom

    California · 43255

    Office

    $778.49

    Facility

    $182.99

    $39.73 higher than Chico for the office setting.

  • Salinas

    California · 43255

    Office

    $775.67

    Facility

    $182.22

    $36.91 higher than Chico for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 43255

    Office

    $796.36

    Facility

    $183.96

    $57.60 higher than Chico for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 43255

    Office

    $922.68

    Facility

    $200.71

    $183.92 higher than Chico for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 43255

    Office

    $922.24

    Facility

    $200.27

    $183.48 higher than Chico for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 43255

    Office

    $943.34

    Facility

    $204.99

    $204.58 higher than Chico for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 43255

    Office

    $941.53

    Facility

    $203.18

    $202.77 higher than Chico for the office setting.

  • San Luis Obispo-Paso Robles

    California · 43255

    Office

    $762.85

    Facility

    $179.64

    $24.09 higher than Chico for the office setting.

  • Santa Cruz-Watsonville

    California · 43255

    Office

    $805.88

    Facility

    $183.76

    $67.12 higher than Chico for the office setting.

  • Santa Maria-Santa Barbara

    California · 43255

    Office

    $779.24

    Facility

    $182.21

    $40.48 higher than Chico for the office setting.

  • Santa Rosa-Petaluma

    California · 43255

    Office

    $814.20

    Facility

    $185.42

    $75.44 higher than Chico for the office setting.

  • Stockton

    California · 43255

    Office

    $738.76

    Facility

    $177.57

    The same base rate than Chico for the office setting.

  • Vallejo

    California · 43255

    Office

    $867.44

    Facility

    $192.57

    $128.68 higher than Chico for the office setting.

  • Visalia

    California · 43255

    Office

    $738.76

    Facility

    $177.57

    The same base rate than Chico for the office setting.

  • Yuba City

    California · 43255

    Office

    $738.76

    Facility

    $177.57

    The same base rate than Chico for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 43255

    Office

    $796.49

    Facility

    $193.32

    $57.73 higher than Chico for the office setting.

  • Miami

    Florida · 43255

    Office

    $731.94

    Facility

    $198.91

    $6.82 lower than Chico for the office setting.

  • Chicago

    Illinois · 43255

    Office

    $709.54

    Facility

    $194.95

    $29.22 lower than Chico for the office setting.

  • Manhattan

    New York · 43255

    Office

    $794.85

    Facility

    $199.87

    $56.09 higher than Chico for the office setting.

  • Alaska*

    Alaska · 43255

    Office

    $777.57

    Facility

    $232.25

    $38.81 higher than Chico for the office setting.

  • Alabama

    Alabama · 43255

    Office

    $613.39

    Facility

    $165.36

    $125.37 lower than Chico for the office setting.

  • Arkansas

    Arkansas · 43255

    Office

    $603.76

    Facility

    $163.93

    $135.00 lower than Chico for the office setting.

  • Arizona

    Arizona · 43255

    Office

    $669.82

    Facility

    $173.66

    $68.94 lower than Chico for the office setting.

  • Colorado

    Colorado · 43255

    Office

    $723.45

    Facility

    $178.64

    $15.31 lower than Chico for the office setting.

  • Connecticut

    Connecticut · 43255

    Office

    $737.24

    Facility

    $185.78

    $1.52 lower than Chico for the office setting.

  • Delaware

    Delaware · 43255

    Office

    $681.60

    Facility

    $175.71

    $57.16 lower than Chico for the office setting.

  • Fort Lauderdale

    Florida · 43255

    Office

    $706.87

    Facility

    $188.18

    $31.89 lower than Chico for the office setting.

  • Rest Of Florida

    Florida · 43255

    Office

    $670.97

    Facility

    $181.46

    $67.79 lower than Chico for the office setting.

  • Atlanta

    Georgia · 43255

    Office

    $700.99

    Facility

    $180.76

    $37.77 lower than Chico for the office setting.

  • Rest Of Georgia

    Georgia · 43255

    Office

    $631.07

    Facility

    $174.33

    $107.69 lower than Chico for the office setting.

  • Hawaii, Guam

    Hawaii · 43255

    Office

    $760.31

    Facility

    $178.13

    $21.55 higher than Chico for the office setting.

  • Iowa

    Iowa · 43255

    Office

    $633.59

    Facility

    $165.08

    $105.17 lower than Chico for the office setting.

  • Idaho

    Idaho · 43255

    Office

    $637.39

    Facility

    $166.31

    $101.37 lower than Chico for the office setting.

  • East St. Louis

    Illinois · 43255

    Office

    $657.46

    Facility

    $186.39

    $81.30 lower than Chico for the office setting.

  • Rest Of Illinois

    Illinois · 43255

    Office

    $647.66

    Facility

    $180.17

    $91.10 lower than Chico for the office setting.

  • Suburban Chicago

    Illinois · 43255

    Office

    $715.05

    Facility

    $189.19

    $23.71 lower than Chico for the office setting.

  • Indiana

    Indiana · 43255

    Office

    $641.48

    Facility

    $166.82

    $97.28 lower than Chico for the office setting.

  • Kansas

    Kansas · 43255

    Office

    $628.83

    Facility

    $165.95

    $109.93 lower than Chico for the office setting.

  • Kentucky

    Kentucky · 43255

    Office

    $625.78

    Facility

    $170.58

    $112.98 lower than Chico for the office setting.

  • New Orleans

    Louisiana · 43255

    Office

    $657.78

    Facility

    $175.96

    $80.98 lower than Chico for the office setting.

  • Rest Of Louisiana

    Louisiana · 43255

    Office

    $624.10

    Facility

    $170.95

    $114.66 lower than Chico for the office setting.

  • Metropolitan Boston

    Massachusetts · 43255

    Office

    $801.05

    Facility

    $189.67

    $62.29 higher than Chico for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 43255

    Office

    $717.96

    Facility

    $178.78

    $20.80 lower than Chico for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 43255

    Office

    $734.89

    Facility

    $185.48

    $3.87 lower than Chico for the office setting.

  • Rest Of Maryland

    Maryland · 43255

    Office

    $695.87

    Facility

    $177.69

    $42.89 lower than Chico for the office setting.

  • Rest Of Maine

    Maine · 43255

    Office

    $639.33

    Facility

    $168.25

    $99.43 lower than Chico for the office setting.

  • Southern Maine

    Maine · 43255

    Office

    $679.21

    Facility

    $171.79

    $59.55 lower than Chico for the office setting.

  • Detroit

    Michigan · 43255

    Office

    $678.39

    Facility

    $184.28

    $60.37 lower than Chico for the office setting.

  • Rest Of Michigan

    Michigan · 43255

    Office

    $642.01

    Facility

    $174.52

    $96.75 lower than Chico for the office setting.

  • Minnesota

    Minnesota · 43255

    Office

    $696.13

    Facility

    $169.25

    $42.63 lower than Chico for the office setting.

  • Metropolitan Kansas City

    Missouri · 43255

    Office

    $654.59

    Facility

    $173.79

    $84.17 lower than Chico for the office setting.

  • Metropolitan St. Louis

    Missouri · 43255

    Office

    $662.20

    Facility

    $174.74

    $76.56 lower than Chico for the office setting.

  • Rest Of Missouri

    Missouri · 43255

    Office

    $611.42

    Facility

    $170.05

    $127.34 lower than Chico for the office setting.

  • Mississippi

    Mississippi · 43255

    Office

    $607.80

    Facility

    $166.94

    $130.96 lower than Chico for the office setting.

  • Montana**

    Montana · 43255

    Office

    $689.03

    Facility

    $177.00

    $49.73 lower than Chico for the office setting.

  • North Carolina

    North Carolina · 43255

    Office

    $646.83

    Facility

    $169.10

    $91.93 lower than Chico for the office setting.

  • North Dakota**

    North Dakota · 43255

    Office

    $681.32

    Facility

    $169.29

    $57.44 lower than Chico for the office setting.

  • Nebraska

    Nebraska · 43255

    Office

    $637.83

    Facility

    $165.22

    $100.93 lower than Chico for the office setting.

  • New Hampshire

    New Hampshire · 43255

    Office

    $710.40

    Facility

    $177.37

    $28.36 lower than Chico for the office setting.

  • Northern Nj

    New Jersey · 43255

    Office

    $786.87

    Facility

    $192.91

    $48.11 higher than Chico for the office setting.

  • Rest Of New Jersey

    New Jersey · 43255

    Office

    $746.49

    Facility

    $187.35

    $7.73 higher than Chico for the office setting.

  • New Mexico

    New Mexico · 43255

    Office

    $645.19

    Facility

    $175.65

    $93.57 lower than Chico for the office setting.

  • Nevada**

    Nevada · 43255

    Office

    $687.45

    Facility

    $174.90

    $51.31 lower than Chico for the office setting.

  • Nyc Suburbs/Long Island

    New York · 43255

    Office

    $813.51

    Facility

    $204.70

    $74.75 higher than Chico for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 43255

    Office

    $750.22

    Facility

    $189.55

    $11.46 higher than Chico for the office setting.

  • Queens

    New York · 43255

    Office

    $804.18

    Facility

    $198.95

    $65.42 higher than Chico for the office setting.

  • Rest Of New York

    New York · 43255

    Office

    $657.19

    Facility

    $170.75

    $81.57 lower than Chico for the office setting.

  • Ohio

    Ohio · 43255

    Office

    $640.43

    Facility

    $172.94

    $98.33 lower than Chico for the office setting.

  • Oklahoma

    Oklahoma · 43255

    Office

    $626.22

    Facility

    $168.97

    $112.54 lower than Chico for the office setting.

  • Portland

    Oregon · 43255

    Office

    $749.76

    Facility

    $180.88

    $11.00 higher than Chico for the office setting.

  • Rest Of Oregon

    Oregon · 43255

    Office

    $682.95

    Facility

    $172.96

    $55.81 lower than Chico for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 43255

    Office

    $716.63

    Facility

    $183.60

    $22.13 lower than Chico for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 43255

    Office

    $642.41

    Facility

    $172.36

    $96.35 lower than Chico for the office setting.

  • Puerto Rico

    Puerto Rico · 43255

    Office

    $695.03

    Facility

    $177.36

    $43.73 lower than Chico for the office setting.

  • Rhode Island

    Rhode Island · 43255

    Office

    $708.34

    Facility

    $179.41

    $30.42 lower than Chico for the office setting.

  • South Carolina

    South Carolina · 43255

    Office

    $644.54

    Facility

    $171.42

    $94.22 lower than Chico for the office setting.

  • South Dakota**

    South Dakota · 43255

    Office

    $680.41

    Facility

    $168.38

    $58.35 lower than Chico for the office setting.

  • Tennessee

    Tennessee · 43255

    Office

    $632.06

    Facility

    $166.62

    $106.70 lower than Chico for the office setting.

  • Austin

    Texas · 43255

    Office

    $720.30

    Facility

    $178.56

    $18.46 lower than Chico for the office setting.

  • Beaumont

    Texas · 43255

    Office

    $637.72

    Facility

    $171.77

    $101.04 lower than Chico for the office setting.

  • Brazoria

    Texas · 43255

    Office

    $682.08

    Facility

    $174.65

    $56.68 lower than Chico for the office setting.

  • Dallas

    Texas · 43255

    Office

    $686.01

    Facility

    $176.03

    $52.75 lower than Chico for the office setting.

  • Fort Worth

    Texas · 43255

    Office

    $680.58

    Facility

    $175.71

    $58.18 lower than Chico for the office setting.

  • Galveston

    Texas · 43255

    Office

    $683.83

    Facility

    $175.37

    $54.93 lower than Chico for the office setting.

  • Houston

    Texas · 43255

    Office

    $690.96

    Facility

    $182.51

    $47.80 lower than Chico for the office setting.

  • Rest Of Texas

    Texas · 43255

    Office

    $659.23

    Facility

    $173.31

    $79.53 lower than Chico for the office setting.

  • Utah

    Utah · 43255

    Office

    $654.12

    Facility

    $172.81

    $84.64 lower than Chico for the office setting.

  • Virginia

    Virginia · 43255

    Office

    $675.71

    Facility

    $172.38

    $63.05 lower than Chico for the office setting.

  • Virgin Islands

    United States Virgin Islands · 43255

    Office

    $695.03

    Facility

    $177.36

    $43.73 lower than Chico for the office setting.

  • Vermont

    Vermont · 43255

    Office

    $677.02

    Facility

    $170.11

    $61.74 lower than Chico for the office setting.

  • Rest Of Washington

    Washington · 43255

    Office

    $717.14

    Facility

    $177.97

    $21.62 lower than Chico for the office setting.

  • Seattle (King Cnty)

    Washington · 43255

    Office

    $819.62

    Facility

    $191.35

    $80.86 higher than Chico for the office setting.

  • Wisconsin

    Wisconsin · 43255

    Office

    $656.52

    Facility

    $165.99

    $82.24 lower than Chico for the office setting.

  • West Virginia

    West Virginia · 43255

    Office

    $621.30

    Facility

    $176.34

    $117.46 lower than Chico for the office setting.

  • Wyoming**

    Wyoming · 43255

    Office

    $685.67

    Facility

    $173.64

    $53.09 lower than Chico for the office setting.

See how rates vary across the country

43255 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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.

$603.76

$841.05

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$777.571
AL$613.391
AR$603.761
AZ$669.821
CA$738.76–$943.3429
CO$723.451
CT$737.241
DC$796.491
DE$681.601
FL$670.97–$731.943
GA$631.07–$700.992
GU$760.311
HI$760.311
IA$633.591
ID$637.391
IL$647.66–$715.054
IN$641.481
KS$628.831
KY$625.781
LA$624.10–$657.782
MA$717.96–$801.052
MD$695.87–$796.493
ME$639.33–$679.212
MI$642.01–$678.392
MN$696.131
MO$611.42–$662.203
MS$607.801
MT$689.031
NC$646.831
ND$681.321
NE$637.831
NH$710.401
NJ$746.49–$786.872
NM$645.191
NV$687.451
NY$657.19–$813.515
OH$640.431
OK$626.221
OR$682.95–$749.762
PA$642.41–$716.632
PR$695.031
RI$708.341
SC$644.541
SD$680.411
TN$632.061
TX$637.72–$720.308
UT$654.121
VA$675.71–$796.492
VI$695.031
VT$677.021
WA$717.14–$819.622
WI$656.521
WV$621.301
WY$685.671

Explore 43255 on the national rate map →

Where does this rate apply?

Chico is a Medicare payment area. Our Census mapping connects it to 30 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 43255 in Chico, the physician’s office rate is $738.76 and the facility-setting rate is $177.57: a difference of $561.19.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 43255 in Chico. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$812.64

$738.76 × 110% = $812.64

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43255 in Chico.

PPRRVU2026_Oct_nonQPP.csv

5,184

Code
43255
Physician work
3.47
Practice expense
16.77
Malpractice
0.39

GPCI2026.csv

9

Locality
Chico
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 43255 in Chico
ComponentRVULocality factorAdjusted
Physician work3.47× 1.0173.5290
Practice expense16.77× 1.09618.3799
Malpractice0.39× 0.5360.2090
Total RVUs22.1180
Conversion factor× 33.4009

Office / nonfacility rate, Chico$738.76

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 43255 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work3.471.017
Practice expense16.771.096
Malpractice0.390.536

(3.47 × 1.017 + 16.77 × 1.096 + 0.39 × 0.536) × $33.4009 = $738.76

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work3.471.017
Practice expense1.441.096
Malpractice0.390.536

(3.47 × 1.017 + 1.44 × 1.096 + 0.39 × 0.536) × $33.4009 = $177.57

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

43255 · Office / nonfacility

$738.76

Effective 2026-10-01

The base rate is $113.41 higher than on 2025-10-01, moving from $625.35 to $738.76 (18.1%).

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

    $625.35changed to$738.76

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.56 changed to 3.47
    • Practice expense RVU 14.17 changed to 16.77
    • Malpractice RVU 0.42 changed to 0.39
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $625.35

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$738.76$177.57RVU26D
2026-07-01$738.76$177.57RVU26C
2026-04-01$738.76$177.57RVU26B
2026-01-01$738.76$177.57RVU26A
2025-10-01$625.35$193.32RVU25D
2025-07-01$625.35$193.32RVU25C
2025-04-01$625.35$193.32RVU25B
2025-01-01$625.35$193.32RVU25A

43255 billing questions

When should this code be chosen over the variceal treatment codes?

Use this code for endoscopic hemostasis such as treatment of a bleeding ulcer. Use 43243 for variceal injection or 43244 for variceal ligation.

Is diagnostic inspection included when hemostasis is performed?

The endoscopic examination that identifies the bleeding site is part of the therapeutic service; do not report a separate diagnostic upper endoscopy for that same session.

What documentation supports reporting this service?

Document the bleeding site and endoscopic findings, the hemostatic method used, and the result of treatment.

Can modifier 50 be used if treatment involves paired anatomy?

No. CMS identifies bilateral adjustment as inappropriate for this code.

How does Medicare price this with another related endoscopy?

Medicare applies endoscopy-family pricing when related endoscopies are performed together, rather than treating each as an independent full standalone service.

Does Medicare pay an assistant or co-surgeon for this procedure?

No. Assistant-at-surgery payment is restricted, and co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 43255PPRRVU2026_Oct_nonQPP.csv, line 5,184 (RVU26D)
Geographic factors for ChicoGPCI2026.csv, line 9 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet