No office rate
43243 describes injection treatment of varices during upper endoscopy. Use 43227 for esophagoscopy with bleeding control when the procedure is not the variceal-injection service.
On this page
CMS RVU26D · Effective 2026-10-01
43227 Esophagoscopy Medicare reimbursement rates in Pennsylvania
Flexible transoral esophagoscopy with endoscopic hemostasis is reported when active esophageal bleeding is treated during the procedure, rather than merely evaluated. Compare 43227 office and facility rates across CMS payment localities in Pennsylvania.
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 43227 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$609.64–$681.86
2 of 2 localities have a supported rate.
Facility setting
$142.96–$152.65
2 of 2 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.
Gastrointestinal endoscopy
About 43227: Esophagoscopy with bleeding control
Flexible transoral esophagoscopy with endoscopic hemostasis is reported when active esophageal bleeding is treated during the procedure, rather than merely evaluated.
A flexible scope is passed through the mouth to inspect the esophagus and treat a bleeding site under direct visualization. Gastroenterologists commonly perform this service in a hospital or ambulatory endoscopy setting for active bleeding from esophageal mucosa or a lesion. Hemostasis may use an endoscopic technique such as injection, thermal treatment, or clips, depending on the source and clinical circumstances.
Report the service when the procedure includes treatment to control esophageal bleeding, not inspection alone. The operative report should identify the bleeding source and describe the hemostatic treatment. When related endoscopies are performed together, CMS endoscopy-family pricing applies. The 0-day global period includes same-day preoperative and postoperative care. The esophagus is not reported bilaterally, so 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 43227
- 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 RVU2.82 · 14%
- Practice expense (office) RVU16.44 · 84%
- Malpractice RVU0.36 · 2%
116
Medicare services in 2024 · #4764 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.
43227 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
43244 describes variceal ligation during upper endoscopy. 43227 is the esophagoscopy service for endoscopic bleeding control.
$727.48–$813.44
43229 is for ablation of an esophageal lesion. Choose 43227 when the documented service is controlling bleeding rather than ablating a lesion as the treatment objective.
$302.00–$335.53
43235 is a diagnostic upper endoscopy service. 43227 requires esophagoscopy with treatment to control bleeding.
Compare 43227 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$681.86
Facility
$152.65
Rest Of Pennsylvania →
Office / nonfacility
$609.64
Facility
$142.96
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43227 billing questions
When should 43227 be chosen over a diagnostic esophagoscopy?
Use 43227 when the esophagoscopy includes endoscopic treatment to control bleeding. Inspection without hemostasis is not this service.
How does 43227 differ from variceal injection or ligation?
43227 represents esophagoscopy with bleeding control. Codes 43243 and 43244 describe variceal treatment performed with upper endoscopy; choose based on the procedure actually performed.
What documentation supports reporting 43227?
Document the esophageal bleeding source and the method used to achieve hemostasis. The record should show treatment of bleeding, rather than observation alone.
Is same-day care included in the payment?
Yes. The 0-day global period includes preoperative and postoperative care on the procedure date.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 43227. Co-surgeons and team surgery are not permitted.
How are related endoscopies handled when performed together?
CMS endoscopy-family pricing applies when related endoscopies are performed together, so payment reflects the family-pricing rules.
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.
5,15443217,,Esophagoscopy snare les remv,A,,2.73,10.98,,1.23,,0.30,14.01,4.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15543220,,Esophagoscopy balloon <30mm,A,,1.95,26.47,,0.96,,0.26,28.68,3.17,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15643226,,Esoph endoscopy dilation,A,,2.18,9.89,,0.97,,0.36,12.43,3.51,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15743227,,Esophagoscopy control bleed,A,,2.82,16.44,,1.22,,0.36,19.62,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15843229,,Esophagoscopy lesion ablate,A,,3.40,19.60,,1.42,,0.41,23.41,5.23,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,1594322F,,Crgvr prov w/ ed addl rsrcs,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
5,16043231,,Esophagoscop ultrasound exam,A,,2.73,1.13,NA,1.13,,0.27,4.13,4.13,0,000,0.00,0.00,0.00,3,0,1,2,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00