Billing code 43205: Variceal bandingMedicare rate & RVUs in Virginia
Reports flexible transoral esophagoscopy with band ligation of esophageal varices, such as treatment of varices associated with portal hypertension.
CMS doesn’t publish an office rate for 43205 in Virginia.
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 43205 covers
A physician uses a flexible scope passed through the mouth to examine the esophagus and place ligating bands on esophageal varices. Gastroenterologists and surgeons commonly perform the procedure in a hospital or ambulatory surgery setting to treat or reduce the risk of bleeding from esophageal varices, including those associated with portal hypertension.
Select this code when the documented therapeutic service is esophageal variceal banding by esophagoscopy; use a code for a broader upper gastrointestinal examination when the service includes that extent of endoscopy. The report should support the scope performed and the ligation of esophageal varices. Routine inspection to identify the varices is part of the therapeutic session, not a separate diagnostic esophagoscopy. This minor procedure has 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. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing 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.
Where 43205 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $137.91 |
| Virginia | Unavailable | $122.73 |
How the 43205 rate is calculated
Each of 43205’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 · 43205
RVUs × geographic indexes × conversion factor
Work2.38
2.38 RVUs× 1.000 GPCI
Practice expense1.13
1.13 RVUs× 1.000 GPCI
Malpractice0.26
0.26 RVUs× 1.000 GPCI
Adjusted RVUs
3.7700
Conversion factor
$33.4009
Medicare rate
$125.92
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43205
The CMS indicators that decide how 43205 is paid alongside other services.
CMS payment indicators · 43205
Variceal banding
| 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
43205 without 51 · national facility
$125.92
Variceal banding
43205-51 · Second procedure: 50%
$62.96
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%).
43205 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43204Variceal injection
- Choose 43205 for band ligation of esophageal varices. Choose 43204 when the documented variceal treatment is injection of a sclerosing agent.
- 43244Variceal ligation
- 43244 describes variceal banding performed through upper endoscopy. Use 43205 when the service is esophagoscopy limited to the esophagus.
- 43200Esophagoscopy
- 43200 is diagnostic flexible esophagoscopy, with brushing or washing when performed. It does not describe therapeutic band ligation of varices.
43205 billing questions
How is this different from 43204?
43205 is for band ligation of esophageal varices. Code 43204 describes esophagoscopy with injection of a sclerosing agent for varices.
When would 43244 be more appropriate?
Use 43244 when the documented procedure is an upper endoscopy with variceal band ligation, rather than esophagoscopy limited to the esophagus.
Can a diagnostic esophagoscopy be billed separately during banding?
The inspection used to locate the varices is part of the therapeutic esophagoscopy. Do not separately report a diagnostic esophagoscopy for that same scope session.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code and anatomy.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery billing 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
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