No office rate
Choose 43243 when the endoscopist injects esophageal varices. This code describes other endoscopic bleeding control.
On this page
CMS RVU26D · Effective 2026-10-01
43255 Bleeding control Medicare reimbursement rates in Illinois
Reports upper endoscopic treatment to stop gastrointestinal bleeding, such as bleeding from an ulcer or other nonvariceal lesion. Compare 43255 office and facility rates across CMS payment localities in Illinois.
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 43255 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
$647.66–$715.05
4 of 4 localities have a supported rate.
Facility setting
$180.17–$194.95
4 of 4 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 43255 pays more and less in Illinois
4 payment localities
$647.66 to $715.05
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 Illinois, from the same CMS release.
No office rate
Choose 43244 for ligation of esophageal varices; this code is for bleeding control by other endoscopic methods.
$472.84–$520.65
43250 describes cautery treatment of a tumor or polyp. Choose this code when the documented service is hemostasis of a bleeding site.
$516.58–$567.95
43251 describes snare removal of a lesion. Choose this code when the endoscopic service is control of bleeding rather than lesion removal.
Compare 43255 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
$709.54
Facility
$194.95
East St. Louis →
Office / nonfacility
$657.46
Facility
$186.39
Rest Of Illinois →
Office / nonfacility
$647.66
Facility
$180.17
Suburban Chicago →
Office / nonfacility
$715.05
Facility
$189.19
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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.
5,18143252,,Egd optical endomicroscopy,A,,2.89,8.05,,1.25,,0.35,11.29,4.49,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18243253,,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