CPT code 43213: Esophageal dilation, retrograde balloon technique2026 Medicare rate & RVUs in Montana
Reports flexible transoral esophagoscopy with retrograde balloon dilation when treatment of an esophageal narrowing uses a retrograde approach.
In Montana, Medicare pays $1,254.16 for 43213 in the office and $225.41 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Montana 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. Montana pays $1,254.16. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$1,254.16
- Los Angeles, CA · California$1,450.72+$196.56
- Washington, DC area · District of Columbia$1,457.32+$203.16
- Miami, FL · Florida$1,332.75+$78.59
- Chicago, IL · Illinois$1,289.64+$35.48
- Manhattan, NY · New York$1,452.11+$197.95
- Alaska · Alaska$1,389.75+$135.59
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Hanford, CACalifornia | $1,350.17 | $222.67 |
| Madera, CACalifornia | $1,350.17 | $222.67 |
| Merced, CACalifornia | $1,350.17 | $222.67 |
| Modesto, CACalifornia | $1,350.17 | $222.67 |
| Napa, CACalifornia | $1,596.50 | $240.61 |
| Oxnard, CACalifornia | $1,446.76 | $230.78 |
| Redding, CACalifornia | $1,350.17 | $222.67 |
| Rest of CaliforniaCalifornia | $1,350.17 | $222.67 |
| Riverside, CACalifornia | $1,357.42 | $229.91 |
| Sacramento, CACalifornia | $1,425.48 | $229.04 |
| Salinas, CACalifornia | $1,420.40 | $228.08 |
| San Diego, CACalifornia | $1,460.39 | $230.00 |
| Marin County, CACalifornia | $1,699.69 | $249.16 |
| San Francisco, CACalifornia | $1,698.93 | $248.40 |
| San Benito County, CACalifornia | $1,738.28 | $254.82 |
| Santa Clara County, CACalifornia | $1,735.16 | $251.71 |
| San Luis Obispo, CACalifornia | $1,396.67 | $224.92 |
| Santa Cruz, CACalifornia | $1,479.44 | $229.51 |
| Santa Maria, CACalifornia | $1,427.52 | $228.00 |
| Santa Rosa, CACalifornia | $1,494.85 | $231.55 |
| Stockton, CACalifornia | $1,350.17 | $222.67 |
| Vallejo, CACalifornia | $1,595.40 | $239.52 |
| Visalia, CACalifornia | $1,350.17 | $222.67 |
| Yuba City, CACalifornia | $1,350.17 | $222.67 |
| ColoradoColorado | $1,320.31 | $225.72 |
| ConnecticutConnecticut | $1,345.17 | $237.21 |
| DelawareDelaware | $1,239.72 | $223.32 |
| Fort Lauderdale, FLFlorida | $1,286.34 | $244.22 |
| Rest of FloridaFlorida | $1,217.89 | $234.41 |
| Atlanta, GAGeorgia | $1,276.45 | $231.25 |
| Rest of GeorgiaGeorgia | $1,141.73 | $224.09 |
| Hawaii, Guam, HIHawaii | $1,392.91 | $223.22 |
| IowaIowa | $1,148.81 | $207.50 |
| IdahoIdaho | $1,155.92 | $209.47 |
| East St. Louis, ILIllinois | $1,190.40 | $243.95 |
| Rest of IllinoisIllinois | $1,172.74 | $233.49 |
| Suburban Chicago, ILIllinois | $1,301.73 | $245.20 |
| IndianaIndiana | $1,163.77 | $210.13 |
| KansasKansas | $1,139.31 | $209.32 |
| KentuckyKentucky | $1,132.29 | $217.73 |
| New Orleans, LALouisiana | $1,193.46 | $225.41 |
| Rest of LouisianaLouisiana | $1,128.93 | $218.49 |
| Metropolitan Boston, MAMassachusetts | $1,467.67 | $239.34 |
| Rest of MassachusettsMassachusetts | $1,309.37 | $226.10 |
| Baltimore area, MDMaryland | $1,340.84 | $237.00 |
| Rest of MarylandMaryland | $1,266.85 | $225.76 |
| Rest of MaineMaine | $1,159.25 | $212.80 |
| Southern Maine, MEMaine | $1,236.22 | $216.73 |
| Detroit, MIMichigan | $1,231.71 | $238.97 |
| Rest of MichiganMichigan | $1,163.03 | $223.78 |
| MinnesotaMinnesota | $1,269.80 | $211.22 |
| Metropolitan Kansas City, MOMissouri | $1,187.74 | $221.74 |
| Metropolitan St. Louis, MOMissouri | $1,202.35 | $222.98 |
| Rest of MissouriMissouri | $1,104.42 | $217.64 |
| MississippiMississippi | $1,098.08 | $212.33 |
| North CarolinaNorth Carolina | $1,173.69 | $213.86 |
| North DakotaNorth Dakota | $1,240.91 | $212.16 |
| NebraskaNebraska | $1,157.03 | $207.50 |
| New HampshireNew Hampshire | $1,295.74 | $224.81 |
| Northern New JerseyNew Jersey | $1,438.21 | $244.86 |
| Rest of New JerseyNew Jersey | $1,361.87 | $238.48 |
| New MexicoNew Mexico | $1,168.96 | $225.60 |
| NevadaNevada | $1,251.55 | $221.77 |
| NYC suburbs and Long Island, NYNew York | $1,487.37 | $264.19 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $1,368.39 | $241.92 |
| Queens, NYNew York | $1,470.51 | $254.53 |
| Rest of New YorkNew York | $1,193.50 | $216.19 |
| OhioOhio | $1,160.32 | $221.07 |
| OklahomaOklahoma | $1,133.53 | $214.85 |
| Portland, OROregon | $1,370.90 | $227.96 |
| Rest of OregonOregon | $1,243.23 | $218.60 |
| Metropolitan Philadelphia, PAPennsylvania | $1,305.56 | $234.64 |
| Rest of PennsylvaniaPennsylvania | $1,164.32 | $219.93 |
| Puerto RicoPuerto Rico | $1,265.76 | $225.70 |
| Rhode IslandRhode Island | $1,290.33 | $227.63 |
| South CarolinaSouth Carolina | $1,168.68 | $218.11 |
| South DakotaSouth Dakota | $1,239.34 | $210.60 |
| TennesseeTennessee | $1,145.45 | $210.32 |
| Austin, TXTexas | $1,314.66 | $226.25 |
| Beaumont, TXTexas | $1,155.31 | $219.15 |
| Brazoria, TXTexas | $1,240.75 | $221.27 |
| Dallas, TXTexas | $1,248.06 | $223.42 |
| Fort Worth, TXTexas | $1,237.54 | $223.19 |
| Galveston, TXTexas | $1,243.99 | $222.44 |
| Houston, TXTexas | $1,256.25 | $234.71 |
| Rest of TexasTexas | $1,196.89 | $220.61 |
| UtahUtah | $1,187.05 | $220.03 |
| VirginiaVirginia | $1,229.24 | $217.99 |
| Virgin Islands, VIUnited States Virgin Islands | $1,265.76 | $225.70 |
| VermontVermont | $1,232.34 | $213.88 |
| Rest of WashingtonWashington | $1,308.12 | $224.85 |
| King County, WAWashington | $1,503.07 | $240.80 |
| WisconsinWisconsin | $1,193.31 | $207.77 |
| West VirginiaWest Virginia | $1,122.21 | $228.23 |
| WyomingWyoming | $1,248.39 | $219.64 |
43213 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,389.75 | 1 |
| AL | $1,109.34 | 1 |
| AR | $1,090.90 | 1 |
| AZ | $1,217.46 | 1 |
| CA | $1,350.17–$1,738.28 | 29 |
| CO | $1,320.31 | 1 |
| CT | $1,345.17 | 1 |
| DC | $1,457.32 | 1 |
| DE | $1,239.72 | 1 |
| FL | $1,217.89–$1,332.75 | 3 |
| GA | $1,141.73–$1,276.45 | 2 |
| GU | $1,392.91 | 1 |
| HI | $1,392.91 | 1 |
| IA | $1,148.81 | 1 |
| ID | $1,155.92 | 1 |
| IL | $1,172.74–$1,301.73 | 4 |
| IN | $1,163.77 | 1 |
| KS | $1,139.31 | 1 |
| KY | $1,132.29 | 1 |
| LA | $1,128.93–$1,193.46 | 2 |
| MA | $1,309.37–$1,467.67 | 2 |
| MD | $1,266.85–$1,457.32 | 3 |
| ME | $1,159.25–$1,236.22 | 2 |
| MI | $1,163.03–$1,231.71 | 2 |
| MN | $1,269.80 | 1 |
| MO | $1,104.42–$1,202.35 | 3 |
| MS | $1,098.08 | 1 |
| MT | $1,254.16 | 1 |
| NC | $1,173.69 | 1 |
| ND | $1,240.91 | 1 |
| NE | $1,157.03 | 1 |
| NH | $1,295.74 | 1 |
| NJ | $1,361.87–$1,438.21 | 2 |
| NM | $1,168.96 | 1 |
| NV | $1,251.55 | 1 |
| NY | $1,193.50–$1,487.37 | 5 |
| OH | $1,160.32 | 1 |
| OK | $1,133.53 | 1 |
| OR | $1,243.23–$1,370.90 | 2 |
| PA | $1,164.32–$1,305.56 | 2 |
| PR | $1,265.76 | 1 |
| RI | $1,290.33 | 1 |
| SC | $1,168.68 | 1 |
| SD | $1,239.34 | 1 |
| TN | $1,145.45 | 1 |
| TX | $1,155.31–$1,314.66 | 8 |
| UT | $1,187.05 | 1 |
| VA | $1,229.24–$1,457.32 | 2 |
| VI | $1,265.76 | 1 |
| VT | $1,232.34 | 1 |
| WA | $1,308.12–$1,503.07 | 2 |
| WI | $1,193.31 | 1 |
| WV | $1,122.21 | 1 |
| WY | $1,248.39 | 1 |
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.
The exact Montana 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
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.51 | × 1.000 | 4.5100 |
| Practice expense | 32.37 | × 1.000 | 32.3700 |
| Malpractice | 0.67 | × 0.998 | 0.6687 |
| Total RVUs | 37.5487 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$1254.16
Office: (4.51 × 1 + 32.37 × 1 + 0.67 × 0.998) × $33.4009 = $1254.16
Facility: (4.51 × 1 + 1.57 × 1 + 0.67 × 0.998) × $33.4009 = $225.41
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%).
How 43213 has changed in Montana
43213 · Office / nonfacility
$1254.16
Effective 2026-10-01
The base rate is $123.49 higher than on 2025-10-01, moving from $1130.67 to $1254.16 (10.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$1130.67changed to$1254.16
- 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
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$1210.12changed to$1130.67
- 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.
March 9, 2024
RVU24AR
$1190.37changed to$1210.12
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$1268.87changed to$1190.37
- 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
January 1, 2023
RVU23A
$1336.61changed to$1268.87
- 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
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$1348.42changed to$1336.61
- 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.
January 1, 2021
RVU21A
$1269.80changed to$1348.42
- 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
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$1235.16changed to$1269.80
- 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
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$1192.99changed to$1235.16
- 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.
January 1, 2018
RVU18AR1
$1182.13changed to$1192.99
- 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
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$1249.38changed to$1182.13
- 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
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$1275.57changed to$1249.38
- 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.
July 1, 2015
RVU15C
$1269.23changed to$1275.57
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$1256.68changed to$1269.23
- 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
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$1256.68
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $1,254.16 | $225.41 | RVU26D |
| 2026-07-01 | $1,254.16 | $225.41 | RVU26C |
| 2026-04-01 | $1,254.16 | $225.41 | RVU26B |
| 2026-01-01 | $1,254.16 | $225.41 | RVU26A |
| 2025-10-01 | $1,130.67 | $248.25 | RVU25D |
| 2025-07-01 | $1,130.67 | $248.25 | RVU25C |
| 2025-04-01 | $1,130.67 | $248.25 | RVU25B |
| 2025-01-01 | $1,130.67 | $248.25 | RVU25A |
| 2024-10-01 | $1,210.12 | $255.11 | RVU24D |
| 2024-07-01 | $1,210.12 | $255.11 | RVU24C |
| 2024-04-01 | $1,210.12 | $255.11 | RVU24B |
| 2024-03-09 | $1,210.12 | $255.11 | RVU24AR |
| 2024-01-01 | $1,190.37 | $250.94 | RVU24A |
| 2023-10-01 | $1,268.87 | $259.03 | RVU23D |
| 2023-07-01 | $1,268.87 | $259.03 | RVU23C |
| 2023-04-01 | $1,268.87 | $259.03 | RVU23B |
| 2023-01-01 | $1,268.87 | $259.03 | RVU23A |
| 2022-10-01 | $1,336.61 | $262.78 | RVU22D |
| 2022-07-01 | $1,336.61 | $262.78 | RVU22C |
| 2022-04-01 | $1,336.61 | $262.78 | RVU22B |
| 2022-01-01 | $1,336.61 | $262.78 | RVU22A |
| 2021-10-01 | $1,348.42 | $262.90 | RVU21D |
| 2021-07-01 | $1,348.42 | $262.90 | RVU21C |
| 2021-04-01 | $1,348.42 | $262.90 | RVU21B |
| 2021-01-01 | $1,348.42 | $262.90 | RVU21A |
| 2020-10-01 | $1,269.80 | $276.97 | RVU20D |
| 2020-07-01 | $1,269.80 | $276.97 | RVU20C |
| 2020-04-01 | $1,269.80 | $276.97 | RVU20B |
| 2020-01-01 | $1,269.80 | $276.97 | RVU20A |
| 2019-10-01 | $1,235.16 | $287.69 | RVU19D |
| 2019-07-01 | $1,235.16 | $287.69 | RVU19C |
| 2019-04-01 | $1,235.16 | $287.69 | RVU19B |
| 2019-01-01 | $1,235.16 | $287.69 | RVU19A |
| 2018-10-01 | $1,192.99 | $287.96 | RVU18D |
| 2018-07-01 | $1,192.99 | $287.96 | RVU18C |
| 2018-04-01 | $1,192.99 | $287.96 | RVU18B |
| 2018-01-01 | $1,192.99 | $287.96 | RVU18AR1 |
| 2017-10-01 | $1,182.13 | $282.40 | RVU17D |
| 2017-07-01 | $1,182.13 | $282.40 | RVU17C |
| 2017-04-01 | $1,182.13 | $282.40 | RVU17B |
| 2017-01-01 | $1,182.13 | $282.40 | RVU17A |
| 2016-10-01 | $1,249.38 | $281.95 | RVU16D |
| 2016-07-01 | $1,249.38 | $281.95 | RVU16C |
| 2016-04-01 | $1,249.38 | $281.95 | RVU16B |
| 2016-01-01 | $1,249.38 | $281.95 | RVU16A |
| 2015-10-01 | $1,275.57 | $287.76 | RVU15D |
| 2015-07-01 | $1,275.57 | $287.76 | RVU15C |
| 2015-04-01 | $1,269.23 | $286.33 | RVU15B |
| 2015-01-01 | $1,269.23 | $286.33 | RVU15A |
| 2014-10-01 | $1,256.68 | $285.17 | RVU14D |
| 2014-07-01 | $1,256.68 | $285.17 | RVU14C |
| 2014-04-01 | $1,256.68 | $285.17 | RVU14B |
| 2014-01-01 | $1,256.68 | $285.17 | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
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
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