Billing code 43255: Bleeding controlMedicare rate & RVUs in Utah
Reports upper endoscopic treatment to stop gastrointestinal bleeding, such as bleeding from an ulcer or other nonvariceal lesion.
Medicare pays $654.12 for 43255 in the office in Utah (Utah). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 43255 covers
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.
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 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $654.12 | $172.81 |
How the 43255 rate is calculated
Each of 43255’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43255
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.47Practice expense 16.77Malpractice 0.39
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43255
The CMS indicators that decide how 43255 is paid alongside other services.
CMS payment indicators · 43255
Bleeding control
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43255 without 51 · national office
$689.06
Bleeding control
43255-51 · Second procedure: 50%
$344.53
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43255 compared with similar codes
Compare codes
43255 vs 43243 vs 43244 vs 43250 vs 43251: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43243Variceal injection
- Choose 43243 when the endoscopist injects esophageal varices. This code describes other endoscopic bleeding control.
- 43244Variceal ligation
- Choose 43244 for ligation of esophageal varices; this code is for bleeding control by other endoscopic methods.
- 43250Upper endoscopy
- 43250 describes cautery treatment of a tumor or polyp. Choose this code when the documented service is hemostasis of a bleeding site.
- 43251EGD lesion removal
- 43251 describes snare removal of a lesion. Choose this code when the endoscopic service is control of bleeding rather than lesion removal.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 43255 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →