No office rate
43243 describes injection treatment of varices; 43244 describes treatment by band ligation.
On this page
CMS RVU26D · Effective 2026-10-01
43243 Variceal injection Medicare reimbursement rates in Ohio
Upper endoscopy with injection therapy for esophageal or gastric varices, reported when the endoscopist treats varices by injecting a sclerosing agent. Compare 43243 office and facility rates across CMS payment localities in Ohio.
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 43243 in Ohio?
Ohio 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
$204.67
1 of 1 localities have a supported rate.
Payment area: Ohio
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.
Gastrointestinal endoscopy
About 43243: Upper endoscopy with variceal injection
Upper endoscopy with injection therapy for esophageal or gastric varices, reported when the endoscopist treats varices by injecting a sclerosing agent.
A gastroenterologist or other qualified endoscopist uses an upper endoscope to locate esophageal or gastric varices and injects them with a sclerosing agent. This treatment may be performed for varices associated with portal hypertension, including when variceal bleeding requires endoscopic intervention. The procedure is typically done in a hospital endoscopy suite or another setting equipped for upper endoscopy and patient monitoring.
Report this code when the documented endoscopic treatment is injection of varices, rather than band ligation or injection of a nonvariceal site. The procedure note should identify the varices treated and describe the injection therapy. CMS 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. CMS does not pay for an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 43243
- 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 RVU4.16 · 66%
- Practice expense (office) RVU1.57 · 25%
- Malpractice RVU0.53 · 8%
251
Medicare services in 2024 · #4137 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.
43243 compared with similar codes
Office rates for Ohio, from the same CMS release.
$415.04
43236 is for upper-GI submucosal injection at a nonvariceal target. Use 43243 when the injection treats esophageal or gastric varices.
$640.43
43255 is for endoscopic control of bleeding. Choose 43243 when the documented treatment is injection therapy directed at varices.
Compare 43243 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
Ohio →
Office / nonfacility
Unavailable
Facility
$204.67
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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 43243 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
5,171
- Code
- 43243
- Physician work
- 4.16
- Practice expense
- 1.57
- Malpractice
- 0.53
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.16 | × 1.000 | 4.1600 |
| Practice expense | 1.57 | × 0.913 | 1.4334 |
| Malpractice | 0.53 | × 1.008 | 0.5342 |
| Total RVUs | 6.1277 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Ohio$204.67
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.16 | 1 |
| Practice expense | 1.57 | 0.913 |
| Malpractice | 0.53 | 1.008 |
(4.16 × 1 + 1.57 × 0.913 + 0.53 × 1.008) × $33.4009 = $204.67
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.
43243 billing questions
How does this differ from variceal band ligation?
Use 43243 for injection treatment of varices. Use 43244 when the endoscopist treats them by applying bands.
Is injection of a nonvariceal lesion reported with this code?
No. Code 43243 is specific to injection treatment of varices; code 43236 describes a different upper-GI injection service.
Can the diagnostic EGD be reported separately?
The diagnostic examination performed as part of the variceal treatment is not a separate diagnostic service. Report the therapeutic service performed.
Should modifier 50 be appended for varices on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
What happens when another related endoscopy is performed at the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included in the 0-day global period.
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.
5,16843240,,Egd w/transmural drain cyst,A,,6.97,2.48,NA,2.48,,0.79,10.24,10.24,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16943241,,Egd tube/cath insertion,A,,2.43,1.07,NA,1.07,,0.30,3.80,3.80,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17043242,,Egd us fine needle bx/aspir,A,,4.61,1.78,NA,1.78,,0.49,6.88,6.88,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17143243,,Egd injection varices,A,,4.16,1.57,NA,1.57,,0.53,6.26,6.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17243244,,Egd varices ligation,A,,4.29,1.69,NA,1.69,,0.47,6.45,6.45,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17343245,,Egd dilate stricture,A,,3.00,16.19,,1.28,,0.42,19.61,4.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17443246,,Egd place gastrostomy tube,A,,3.47,1.34,NA,1.34,,0.53,5.34,5.34,0,000,0.00,0.00,0.00,3,0,0,2,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703