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CPT code 43213: Esophageal dilation, retrograde balloon technique2026 Medicare rate & RVUs in Detroit, MI

Reports flexible transoral esophagoscopy with retrograde balloon dilation when treatment of an esophageal narrowing uses a retrograde approach.

CMS RVU26DEffective Oct 1, 2026One payment locality102 Medicare services in 2024

In Detroit, MI, Medicare pays $1,231.71 for 43213 in the office and $238.97 when it’s performed in a hospital or facility.

$1,231.71Office (non-facility)
$238.97Hospital or facility
−1.8%vs the national office rate ($1,254.20)

Check a contract rate as a % of Medicare · 43213 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 43213 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Detroit, MI
  2. What 43213 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 43213 covers

This service combines flexible transoral esophagoscopy with balloon dilation of an esophageal narrowing using a retrograde approach. It is typically performed by a gastroenterologist or otolaryngologist in an endoscopy suite or operating room when the narrowing is approached from the opposite direction from standard antegrade balloon dilation. The record should identify the esophageal site, the narrowing treated, the retrograde technique, and the balloon dilation performed.

Report the procedure for the retrograde approach, not simply because a balloon was used; standard balloon dilation is distinguished by its approach and, in related codes, balloon diameter. The 0-day global period includes same-day preoperative and postoperative care. 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-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.

How Detroit, MI compares for 43213

Across 109 of 109 payment localities, the office rate for 43213 runs from $1,090.90 in Arkansas to $1,738.28 in San Benito County, CA. Detroit, MI pays $1,231.71. The RVUs are the same everywhere; the geographic indexes change the dollars.

43213 in Detroit, MI vs other payment areas
  1. Detroit, MI · this page$1,231.71
  2. Rest of Michigan · Michigan$1,163.03−$68.68
  3. Los Angeles, CA · California$1,450.72+$219.01
  4. Washington, DC area · District of Columbia$1,457.32+$225.61
  5. Miami, FL · Florida$1,332.75+$101.04
  6. Chicago, IL · Illinois$1,289.64+$57.93
  7. Manhattan, NY · New York$1,452.11+$220.40

Other areas in Michigan first, then benchmark localities. Bars start at $0.

Every other payment area

43213 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$1,389.75$294.14
AlabamaAlabama$1,109.34$209.19
ArkansasArkansas$1,090.90$207.21
ArizonaArizona$1,217.46$220.61
Bakersfield, CACalifornia$1,352.11$224.60
Chico, CACalifornia$1,350.17$222.67
El Centro, CACalifornia$1,350.29$222.78
Fresno, CACalifornia$1,350.17$222.67

43213 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$1,090.90

$1,544.23

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
43213 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,389.751
AL$1,109.341
AR$1,090.901
AZ$1,217.461
CA$1,350.17–$1,738.2829
CO$1,320.311
CT$1,345.171
DC$1,457.321
DE$1,239.721
FL$1,217.89–$1,332.753
GA$1,141.73–$1,276.452
GU$1,392.911
HI$1,392.911
IA$1,148.811
ID$1,155.921
IL$1,172.74–$1,301.734
IN$1,163.771
KS$1,139.311
KY$1,132.291
LA$1,128.93–$1,193.462
MA$1,309.37–$1,467.672
MD$1,266.85–$1,457.323
ME$1,159.25–$1,236.222
MI$1,163.03–$1,231.712
MN$1,269.801
MO$1,104.42–$1,202.353
MS$1,098.081
MT$1,254.161
NC$1,173.691
ND$1,240.911
NE$1,157.031
NH$1,295.741
NJ$1,361.87–$1,438.212
NM$1,168.961
NV$1,251.551
NY$1,193.50–$1,487.375
OH$1,160.321
OK$1,133.531
OR$1,243.23–$1,370.902
PA$1,164.32–$1,305.562
PR$1,265.761
RI$1,290.331
SC$1,168.681
SD$1,239.341
TN$1,145.451
TX$1,155.31–$1,314.668
UT$1,187.051
VA$1,229.24–$1,457.322
VI$1,265.761
VT$1,232.341
WA$1,308.12–$1,503.072
WI$1,193.311
WV$1,122.211
WY$1,248.391

See 43213 in every payment locality

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

Office or facility?

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.

The exact Detroit, MI inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,150

Code
43213
Physician work
4.51
Practice expense
32.37
Malpractice
0.67

GPCI2026.csv

64

Locality
Detroit, MI
Physician work
1.000
Practice expense
0.965
Malpractice
1.686
Office calculation for 43213 in Detroit, MI
ComponentRVULocality factorAdjusted
Physician work4.51× 1.0004.5100
Practice expense32.37× 0.96531.2370
Malpractice0.67× 1.6861.1296
Total RVUs36.8767
Conversion factor× 33.4009

Office rate, Detroit, MI$1231.71

Office: (4.51 × 1 + 32.37 × 0.965 + 0.67 × 1.686) × $33.4009 = $1231.71

Facility: (4.51 × 1 + 1.57 × 0.965 + 0.67 × 1.686) × $33.4009 = $238.97

Open 43213 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 43213

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 43213
CodeHow it relatesOffice range, Detroit, MI
Used instead
43214Esophageal dilation, balloon 30 mm or largerBalloon dilation code distinguished by a 30 mm diameter threshold, rather than a retrograde approach.No office rate
43220Esophageal dilation, balloon under 30 mmFor esophageal balloon dilation with a balloon under 30 mm, rather than retrograde dilation.$932.95
43226Esophageal dilation, over guidewireDescribes esophageal dilation over a guide wire, a different dilation technique.$411.86

How 43213 has changed in Detroit, MI

43213 · Office / nonfacility

$1231.71

Effective 2026-10-01

The base rate is $97.51 higher than on 2025-10-01, moving from $1134.20 to $1231.71 (8.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $1134.20changed to$1231.71

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.63 changed to 4.51
    • Practice expense RVU 29.65 changed to 32.37
    • Malpractice RVU 0.69 changed to 0.67
    • Work GPCI 1.003 changed to 1.000
    • Practice expense GPCI 0.986 changed to 0.965
    • Malpractice GPCI 1.718 changed to 1.686

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1214.37changed to$1134.20

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 31.00 changed to 29.65
    • Malpractice RVU 0.74 changed to 0.69

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1194.55changed to$1214.37

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1277.29changed to$1194.55

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 32.10 changed to 31.00
    • Malpractice RVU 0.73 changed to 0.74
    • Work GPCI 1.000 changed to 1.003
    • Practice expense GPCI 0.992 changed to 0.986
    • Malpractice GPCI 1.670 changed to 1.718

  5. January 1, 2023

    RVU23A

    $1349.23changed to$1277.29

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 33.29 changed to 32.10
    • Malpractice RVU 0.72 changed to 0.73
    • Practice expense GPCI 0.997 changed to 0.992
    • Malpractice GPCI 1.622 changed to 1.670

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1360.23changed to$1349.23

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 33.35 changed to 33.29
    • Malpractice RVU 0.68 changed to 0.72

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $1270.44changed to$1360.23

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 29.72 changed to 33.35
    • Malpractice RVU 0.64 changed to 0.68
    • Practice expense GPCI 0.993 changed to 0.997
    • Malpractice GPCI 1.657 changed to 1.622

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1225.29changed to$1270.44

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 28.55 changed to 29.72
    • Malpractice RVU 0.67 changed to 0.64
    • Practice expense GPCI 0.989 changed to 0.993
    • Malpractice GPCI 1.691 changed to 1.657

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $1183.61changed to$1225.29

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 27.40 changed to 28.55
    • Malpractice RVU 0.68 changed to 0.67

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $1176.16changed to$1183.61

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 27.38 changed to 27.40
    • Malpractice RVU 0.65 changed to 0.68
    • Practice expense GPCI 0.992 changed to 0.989
    • Malpractice GPCI 1.510 changed to 1.691

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1245.40changed to$1176.16

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 4.73 changed to 4.63
    • Practice expense RVU 29.38 changed to 27.38
    • Malpractice RVU 0.64 changed to 0.65
    • Practice expense GPCI 0.994 changed to 0.992
    • Malpractice GPCI 1.328 changed to 1.510

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1271.69changed to$1245.40

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 29.91 changed to 29.38
    • Malpractice RVU 0.70 changed to 0.64

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $1265.36changed to$1271.69

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1277.66changed to$1265.36

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 29.57 changed to 29.91
    • Malpractice RVU 0.67 changed to 0.70
    • Work GPCI 1.010 changed to 1.000
    • Practice expense GPCI 1.009 changed to 0.994
    • Malpractice GPCI 1.571 changed to 1.328

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$1277.66

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$1,231.71$238.97RVU26D
2026-07-01$1,231.71$238.97RVU26C
2026-04-01$1,231.71$238.97RVU26B
2026-01-01$1,231.71$238.97RVU26A
2025-10-01$1,134.20$264.15RVU25D
2025-07-01$1,134.20$264.15RVU25C
2025-04-01$1,134.20$264.15RVU25B
2025-01-01$1,134.20$264.15RVU25A
2024-10-01$1,214.37$272.72RVU24D
2024-07-01$1,214.37$272.72RVU24C
2024-04-01$1,214.37$272.72RVU24B
2024-03-09$1,214.37$272.72RVU24AR
2024-01-01$1,194.55$268.27RVU24A
2023-10-01$1,277.29$275.53RVU23D
2023-07-01$1,277.29$275.53RVU23C
2023-04-01$1,277.29$275.53RVU23B
2023-01-01$1,277.29$275.53RVU23A
2022-10-01$1,349.23$278.62RVU22D
2022-07-01$1,349.23$278.62RVU22C
2022-04-01$1,349.23$278.62RVU22B
2022-01-01$1,349.23$278.62RVU22A
2021-10-01$1,360.23$277.97RVU21D
2021-07-01$1,360.23$277.97RVU21C
2021-04-01$1,360.23$277.97RVU21B
2021-01-01$1,360.23$277.97RVU21A
2020-10-01$1,270.44$284.57RVU20D
2020-07-01$1,270.44$284.57RVU20C
2020-04-01$1,270.44$284.57RVU20B
2020-01-01$1,270.44$284.57RVU20A
2019-10-01$1,225.29$288.24RVU19D
2019-07-01$1,225.29$288.24RVU19C
2019-04-01$1,225.29$288.24RVU19B
2019-01-01$1,225.29$288.24RVU19A
2018-10-01$1,183.61$288.54RVU18D
2018-07-01$1,183.61$288.54RVU18C
2018-04-01$1,183.61$288.54RVU18B
2018-01-01$1,183.61$288.54RVU18AR1
2017-10-01$1,176.16$283.63RVU17D
2017-07-01$1,176.16$283.63RVU17C
2017-04-01$1,176.16$283.63RVU17B
2017-01-01$1,176.16$283.63RVU17A
2016-10-01$1,245.40$283.78RVU16D
2016-07-01$1,245.40$283.78RVU16C
2016-04-01$1,245.40$283.78RVU16B
2016-01-01$1,245.40$283.78RVU16A
2015-10-01$1,271.69$289.81RVU15D
2015-07-01$1,271.69$289.81RVU15C
2015-04-01$1,265.36$288.36RVU15B
2015-01-01$1,265.36$288.36RVU15A
2014-10-01$1,277.66$297.40RVU14D
2014-07-01$1,277.66$297.40RVU14C
2014-04-01$1,277.66$297.40RVU14B
2014-01-01$1,277.66$297.40RVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 43213 for an earlier date of service

Where the Detroit, MI rate applies

Detroit, MI is a Medicare payment area, not a city. Our Census mapping connects it to 98 cities and communities in Michigan. Some span more than one payment area; confirm with the service ZIP.

  • Detroit
  • Allen Park
  • Ann Arbor
  • Armada
  • Auburn Hills
  • Barton Hills
  • Belleville
  • Berkley

Browse all communities in Michigan

43213 billing questions

How is 43213 distinguished from other esophageal balloon dilation codes?

43213 identifies retrograde balloon dilation. Codes such as 43220 and 43214 describe balloon dilation by diameter, while 43226 describes dilation over a guide wire.

What documentation supports reporting 43213?

Document the esophageal narrowing and site, the retrograde approach, and the balloon dilation performed. The record should make clear why the procedure was retrograde rather than a standard antegrade dilation.

Can modifier 50 be reported?

No. The anatomy or descriptor makes bilateral reporting with modifier 50 inappropriate.

How are related endoscopies handled when performed in the same session?

CMS endoscopy family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included in the 0-day global period.

Can an assistant, co-surgeon, or surgical team be reported?

Medicare does not pay an assistant at surgery for 43213. 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
RVUs for 43213PPRRVU2026_Oct_nonQPP.csv, line 5,150 (RVU26D)
Geographic factors for Detroit, MIGPCI2026.csv, line 64 (RVU26D)

Open CMS sourceHow we calculate rates

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