$272.45
43204 is for sclerosant injection into esophageal varices; 43201 describes injection into the esophageal submucosa for another therapeutic purpose.
On this page
CMS RVU26D · Effective 2026-10-01
43204 Variceal injection Medicare reimbursement rates in Vermont
Flexible esophagoscopy with sclerosant injection treats esophageal varices through endoscopic delivery of therapy, including in patients with variceal bleeding. Compare 43204 office and facility rates across CMS payment localities in Vermont.
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 43204 in Vermont?
Vermont 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
$116.09
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Endoscopy
About 43204: Esophageal variceal sclerotherapy
Flexible esophagoscopy with sclerosant injection treats esophageal varices through endoscopic delivery of therapy, including in patients with variceal bleeding.
This service uses flexible transoral esophagoscopy to deliver a sclerosant to esophageal varices, with the goal of obliterating the treated vessels. Gastroenterologists and other physicians trained in therapeutic endoscopy perform it for esophageal varices, including in patients with portal-hypertension-related upper gastrointestinal bleeding. The procedure may take place in a hospital endoscopy unit or an ambulatory surgery setting. The target is the varix, not general medication injection into the esophageal wall.
Report 43204 when the record supports endoscopic variceal sclerotherapy, including the indication, findings, varices treated, and sclerosant delivery. Use 43201 for a different submucosal injection service, or 43205 when varices are treated by ligation. 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 governs payment. Modifier 50 is inappropriate for this esophageal service. Medicare assistant-at-surgery payment is barred; co-surgeons and team surgery are not permitted.
CMS billing rules for 43204
- 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 RVU2.27 · 63%
- Practice expense (office) RVU1.09 · 30%
- Malpractice RVU0.25 · 7%
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.
43204 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
Choose 43204 for variceal sclerotherapy and 43205 when the documented treatment is endoscopic ligation.
$316.23
43204 is therapeutic esophagoscopy for variceal sclerosis. 43235 describes diagnostic upper endoscopy with brushings or washings, not variceal injection.
Compare 43204 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
Vermont →
Office / nonfacility
Unavailable
Facility
$116.09
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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 43204 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,143
- Code
- 43204
- Physician work
- 2.27
- Practice expense
- 1.09
- Malpractice
- 0.25
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.27 | × 1.000 | 2.2700 |
| Practice expense | 1.09 | × 0.990 | 1.0791 |
| Malpractice | 0.25 | × 0.506 | 0.1265 |
| Total RVUs | 3.4756 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$116.09
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.27 | 1 |
| Practice expense | 1.09 | 0.99 |
| Malpractice | 0.25 | 0.506 |
(2.27 × 1 + 1.09 × 0.99 + 0.25 × 0.506) × $33.4009 = $116.09
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.
43204 billing questions
When should I report 43204 instead of 43201?
Report 43204 for sclerosant injection directed at esophageal varices. Code 43201 describes a different injection service involving the esophageal submucosa.
How is 43204 different from variceal ligation?
43204 represents treatment by sclerosant injection. When the physician treats the varices by ligation, consider 43205 instead.
Can diagnostic esophagoscopy be separately reported with 43204?
Do not separately report a diagnostic esophagoscopy solely for inspection or access integral to the sclerotherapy session. The record should identify the therapeutic work performed.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this esophageal service.
What documentation supports 43204?
Document the indication and endoscopic findings, identify the esophageal varices treated, and record the sclerosant injection performed.
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.
5,14043200,,Esophagoscopy flexible brush,A,,1.38,7.00,,0.79,,0.21,8.59,2.38,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,14143201,,Esoph scope w/submucous inj,A,,1.68,6.43,,0.86,,0.22,8.33,2.76,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14243202,,Esophagoscopy flex biopsy,A,,1.68,9.88,,0.90,,0.21,11.77,2.79,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14343204,,Esoph scope w/sclerosis inj,A,,2.27,1.09,NA,1.09,,0.25,3.61,3.61,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14443205,,Esophagus endoscopy/ligation,A,,2.38,1.13,NA,1.13,,0.26,3.77,3.77,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14543206,,Esoph optical endomicroscopy,A,,2.23,7.72,,1.08,,0.24,10.19,3.55,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,1464320F,,Pt talk psychsoc&rx oh dpnd,I,,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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817