Billing code 43204: Variceal injectionMedicare rate & RVUs in Florida
Flexible esophagoscopy with sclerosant injection treats esophageal varices through endoscopic delivery of therapy, including in patients with variceal bleeding.
CMS doesn’t publish an office rate for 43204 in Florida.
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 9 sections
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 in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $127.80 |
| Miami | Unavailable | $134.84 |
| Rest Of Florida | Unavailable | $123.18 |
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
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
| 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
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%).
43204 compared with similar codes
Compare codes
43204 vs 43201 vs 43205 vs 43235: national Medicare rates
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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.
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
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