No office rate
Choose 43205 for band ligation of esophageal varices. Choose 43204 when the documented variceal treatment is injection of a sclerosing agent.
On this page
CMS RVU26D · Effective 2026-10-01
43205 Variceal banding Medicare reimbursement rates in Florida
Reports flexible transoral esophagoscopy with band ligation of esophageal varices, such as treatment of varices associated with portal hypertension. Compare 43205 office and facility rates across CMS payment localities in Florida.
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 43205 in Florida?
Florida has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$128.63–$140.75
3 of 3 localities have a supported rate.
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.
Where 43205 pays more and less in Florida
Gastrointestinal endoscopy
About 43205: Esophageal variceal band ligation
Reports flexible transoral esophagoscopy with band ligation of esophageal varices, such as treatment of varices associated with portal hypertension.
A physician uses a flexible scope passed through the mouth to examine the esophagus and place ligating bands on esophageal varices. Gastroenterologists and surgeons commonly perform the procedure in a hospital or ambulatory surgery setting to treat or reduce the risk of bleeding from esophageal varices, including those associated with portal hypertension.
Select this code when the documented therapeutic service is esophageal variceal banding by esophagoscopy; use a code for a broader upper gastrointestinal examination when the service includes that extent of endoscopy. The report should support the scope performed and the ligation of esophageal varices. Routine inspection to identify the varices is part of the therapeutic session, not a separate diagnostic esophagoscopy. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 43205
- 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 RVU2.38 · 63%
- Practice expense (office) RVU1.13 · 30%
- Malpractice RVU0.26 · 7%
50
Medicare services in 2024 · #5355 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.
43205 compared with similar codes
Office rates for Florida, from the same CMS release.
No office rate
43244 describes variceal banding performed through upper endoscopy. Use 43205 when the service is esophagoscopy limited to the esophagus.
$280.15–$307.22
43200 is diagnostic flexible esophagoscopy, with brushing or washing when performed. It does not describe therapeutic band ligation of varices.
Compare 43205 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.
3 of 3 payment localities
Fort Lauderdale →
Office / nonfacility
Unavailable
Facility
$133.43
Miami →
Office / nonfacility
Unavailable
Facility
$140.75
Rest Of Florida →
Office / nonfacility
Unavailable
Facility
$128.63
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43205 billing questions
How is this different from 43204?
43205 is for band ligation of esophageal varices. Code 43204 describes esophagoscopy with injection of a sclerosing agent for varices.
When would 43244 be more appropriate?
Use 43244 when the documented procedure is an upper endoscopy with variceal band ligation, rather than esophagoscopy limited to the esophagus.
Can a diagnostic esophagoscopy be billed separately during banding?
The inspection used to locate the varices is part of the therapeutic esophagoscopy. Do not separately report a diagnostic esophagoscopy for that same scope session.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code and anatomy.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery billing 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.
5,14143201,,Esoph scope w/submucous inj,A,,1.68,6.43,,0.86,,0.22,8.33,2.76,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14243202,,Esophagoscopy flex biopsy,A,,1.68,9.88,,0.90,,0.21,11.77,2.79,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14343204,,Esoph scope w/sclerosis inj,A,,2.27,1.09,NA,1.09,,0.25,3.61,3.61,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14443205,,Esophagus endoscopy/ligation,A,,2.38,1.13,NA,1.13,,0.26,3.77,3.77,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14543206,,Esoph optical endomicroscopy,A,,2.23,7.72,,1.08,,0.24,10.19,3.55,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,1464320F,,Pt talk psychsoc&rx oh dpnd,I,,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
5,14743210,,Egd esophagogastrc fndoplsty,A,,7.56,2.70,NA,2.70,,1.10,11.36,11.36,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00