No office rate
43254 describes endoscopic mucosal resection. Choose 43270 when the lesion is ablated rather than resected.
On this page
CMS RVU26D · Effective 2026-10-01
43270 Lesion ablation Medicare reimbursement rates in Rhode Island
Report this service when an upper endoscopy is used to ablate a tumor, polyp, or other upper-GI lesion rather than remove it conventionally. Compare 43270 office and facility rates across CMS payment localities in Rhode Island.
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 43270 in Rhode Island?
Rhode Island 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
$825.21
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$200.36
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Gastroenterology
About 43270: Upper endoscopy lesion ablation
Report this service when an upper endoscopy is used to ablate a tumor, polyp, or other upper-GI lesion rather than remove it conventionally.
During an upper endoscopy, a gastroenterologist or other qualified physician applies an ablative method to a tumor, polyp, or other lesion in the upper gastrointestinal tract. Examples include radiofrequency ablation of Barrett’s esophagus with dysplasia and argon plasma coagulation of selected mucosal lesions. The service is performed in settings equipped for therapeutic endoscopy, including hospital outpatient departments and ambulatory surgery centers.
Select this service when the lesion is treated by ablation rather than removed with a snare, hot biopsy forceps, or bipolar cautery. The report should identify the lesion’s location, the ablation performed, and the clinical reason for choosing ablation. 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 applies. Modifier 50 is inappropriate for this upper-GI service. CMS does not pay for an assistant at surgery, and co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 43270
- 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 RVU3.91 · 16%
- Practice expense (office) RVU19.68 · 82%
- Malpractice RVU0.44 · 2%
18.4K
Medicare services in 2024 · #1179 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.
43270 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$708.34
43255 is for endoscopic control of bleeding. Use 43270 for lesion ablation, not merely to treat hemorrhage.
No office rate
43257 describes thermal treatment directed at GERD. 43270 addresses ablation of an upper-GI tumor, polyp, or other lesion.
No office rate
43278 is an ERCP service for ablation of a biliary or pancreatic duct lesion, with dilation when performed; 43270 is for upper-GI endoscopy.
Compare 43270 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
Rhode Island →
Office / nonfacility
$825.21
Facility
$200.36
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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 43270 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,196
- Code
- 43270
- Physician work
- 3.91
- Practice expense
- 19.68
- Malpractice
- 0.44
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.91 | × 1.019 | 3.9843 |
| Practice expense | 19.68 | × 1.033 | 20.3294 |
| Malpractice | 0.44 | × 0.892 | 0.3925 |
| Total RVUs | 24.7062 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$825.21
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.91 | 1.019 |
| Practice expense | 19.68 | 1.033 |
| Malpractice | 0.44 | 0.892 |
(3.91 × 1.019 + 19.68 × 1.033 + 0.44 × 0.892) × $33.4009 = $825.21
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.91 | 1.019 |
| Practice expense | 1.57 | 1.033 |
| Malpractice | 0.44 | 0.892 |
(3.91 × 1.019 + 1.57 × 1.033 + 0.44 × 0.892) × $33.4009 = $200.36
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.
43270 billing questions
When should this be reported instead of 43254?
Report 43270 for ablation of an upper-GI lesion. Use 43254 when the physician removes a lesion by endoscopic mucosal resection.
Can diagnostic inspection of the upper GI tract be billed separately?
The endoscopic inspection used to locate and treat the lesion is part of the therapeutic service. Do not report a separate diagnostic endoscopy for that same inspection.
Should modifier 50 be appended for lesions on both sides?
No. Modifier 50 is inappropriate for this upper-GI endoscopic service.
What documentation supports reporting this service?
Document the lesion’s location and nature, the ablation method, and why ablation was selected rather than conventional removal.
Are assistant or co-surgeon modifiers payable?
CMS does not pay for an assistant at surgery for this code. Co-surgeon and team-surgery reporting are not permitted.
How does CMS price this with another endoscopy in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together; the services are priced under that family rule.
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.
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5,19443266,,Egd endoscopic stent place,A,,3.82,1.46,NA,1.46,,0.48,5.76,5.76,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
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5,19643270,,Egd lesion ablation,A,,3.91,19.68,,1.57,,0.44,24.03,5.92,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,19743273,,Endoscopic pancreatoscopy,A,,2.18,0.64,NA,0.64,,0.23,3.05,3.05,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,19843274,,Ercp duct stent placement,A,,8.27,2.85,NA,2.85,,0.92,12.04,12.04,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,19943275,,Ercp remove forgn body duct,A,,6.69,2.38,NA,2.38,,0.76,9.83,9.83,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537