CPT code 43213: Esophageal dilation, retrograde balloon technique2026 Medicare rate & RVUs in Barrington, Illinois
CPT 43213: $1,289.64–$1,301.73 office ($245.20–$255.75 facility) across 2 localities in Barrington, IL in 2026 Medicare. Compare each area.
Medicare pays $1,289.64–$1,301.73 for 43213 in the office in Barrington, Illinois, from Chicago, IL to Suburban Chicago, IL. 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 6 sections
Where 43213 pays more and less in Barrington, Illinois
Barrington, Illinois maps to 2 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $1,289.64 | $255.75 |
| Suburban Chicago, IL | $1,301.73 | $245.20 |
How payment areas work in Barrington
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- Chicago · Cook County
- Suburban Chicago · Lake County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
How the 43213 rate is calculated
Each of 43213’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 · 43213
RVUs × geographic indexes × conversion factor
Work4.51
4.51 RVUs× 1.000 GPCI
Practice expense32.37
32.37 RVUs× 1.000 GPCI
Malpractice0.67
0.67 RVUs× 1.000 GPCI
Adjusted RVUs
37.5500
Conversion factor
$33.4009
Medicare rate
$1,254.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43213
The CMS indicators that decide how 43213 is paid alongside other services.
CMS payment indicators · 43213
Esophageal dilation, retrograde balloon technique
| 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
43213 without 51 · national office
$1,254.20
Esophageal dilation, retrograde balloon technique
43213-51 · Second procedure: 50%
$627.10
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%).
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 · Coming soon
Put 43213 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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