$344.68
Use 43257 when thermal treatment for GERD is delivered. Use 43235 for a diagnostic upper endoscopy without that therapeutic treatment.
On this page
CMS RVU26D · Effective 2026-10-01
43257 GERD endoscopy Medicare reimbursement rates in Connecticut
Report this service when upper endoscopy is used to deliver thermal treatment at the gastroesophageal junction for gastroesophageal reflux disease. Compare 43257 office and facility rates across CMS payment localities in Connecticut.
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.
What does Medicare pay for 43257 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$214.44
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Gastroenterology
About 43257: Endoscopic thermal treatment for gastroesophageal reflux
Report this service when upper endoscopy is used to deliver thermal treatment at the gastroesophageal junction for gastroesophageal reflux disease.
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.
CMS billing rules for 43257
- 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 RVU4.05 · 66%
- Practice expense (office) RVU1.62 · 26%
- Malpractice RVU0.45 · 7%
61
Medicare services in 2024 · #5229 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.
43257 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$858.94
43270 treats an endoscopically identified lesion with ablation. 43257 is for thermal treatment directed at GERD, not a focal lesion.
$737.24
43255 is reported for endoscopic control of bleeding. 43257 describes thermal treatment for GERD, not hemostasis.
Compare 43257 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
Unavailable
Facility
$214.44
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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 43257 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,185
- Code
- 43257
- Physician work
- 4.05
- Practice expense
- 1.62
- Malpractice
- 0.45
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.05 | × 1.020 | 4.1310 |
| Practice expense | 1.62 | × 1.077 | 1.7447 |
| Malpractice | 0.45 | × 1.210 | 0.5445 |
| Total RVUs | 6.4202 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$214.44
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.05 | 1.02 |
| Practice expense | 1.62 | 1.077 |
| Malpractice | 0.45 | 1.21 |
(4.05 × 1.02 + 1.62 × 1.077 + 0.45 × 1.21) × $33.4009 = $214.44
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.
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 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.
5,18243253,,Egd us transmural injxn/mark,A,,4.61,1.78,NA,1.78,,0.50,6.89,6.89,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18343254,,Egd endo mucosal resection,A,,4.75,1.81,NA,1.81,,0.53,7.09,7.09,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18443255,,Egd control bleeding any,A,,3.47,16.77,,1.44,,0.39,20.63,5.30,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18543257,,Egd w/thrml txmnt gerd,A,,4.05,1.62,NA,1.62,,0.45,6.12,6.12,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18643259,,Egd us exam duodenum/jejunum,A,,3.94,1.58,NA,1.58,,0.43,5.95,5.95,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,1874325F,,Med txmnt options rvwd w/pt,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,18843260,,Ercp w/specimen collection,A,,5.70,2.09,NA,2.09,,0.62,8.41,8.41,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808