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CPT code 43213: Esophageal dilation, retrograde balloon technique2026 Medicare rate & RVUs in Queens, NY

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 Queens, NY, Medicare pays $1,470.51 for 43213 in the office and $254.53 when it’s performed in a hospital or facility.

$1,470.51Office (non-facility)
$254.53Hospital or facility
+17.2%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 Queens, NY
  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 Queens, NY 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. Queens, NY pays $1,470.51. The RVUs are the same everywhere; the geographic indexes change the dollars.

43213 in Queens, NY vs other payment areas
  1. Queens, NY · this page$1,470.51
  2. Manhattan, NY · New York$1,452.11−$18.40
  3. NYC suburbs and Long Island, NY · New York$1,487.37+$16.86
  4. Poughkeepsie and northern NYC suburbs, NY · New York$1,368.39−$102.12
  5. Rest of New York · New York$1,193.50−$277.01
  6. Los Angeles, CA · California$1,450.72−$19.79
  7. Washington, DC area · District of Columbia$1,457.32−$13.19

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

Every other payment area

43213 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$1,332.75$261.82
Chicago, ILIllinois$1,289.64$255.75
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

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 Queens, NY 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

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 43213 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work4.51× 1.0644.7986
Practice expense32.37× 1.18238.2613
Malpractice0.67× 1.4420.9661
Total RVUs44.0261
Conversion factor× 33.4009

Office rate, Queens, NY$1470.51

Office: (4.51 × 1.064 + 32.37 × 1.182 + 0.67 × 1.442) × $33.4009 = $1470.51

Facility: (4.51 × 1.064 + 1.57 × 1.182 + 0.67 × 1.442) × $33.4009 = $254.53

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, Queens, NY
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.$1,126.85
43226Esophageal dilation, over guidewireDescribes esophageal dilation over a guide wire, a different dilation technique.$485.27

How 43213 has changed in Queens, NY

43213 · Office / nonfacility

$1470.51

Effective 2026-10-01

The base rate is $132.29 higher than on 2025-10-01, moving from $1338.22 to $1470.51 (9.9%).

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

    $1338.22changed to$1470.51

    • 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 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1433.29changed to$1338.22

    • 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

    $1409.89changed to$1433.29

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1535.84changed to$1409.89

    • 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 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $1650.21changed to$1535.84

    • 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
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1662.75changed to$1650.21

    • 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

    $1533.46changed to$1662.75

    • 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
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1461.45changed to$1533.46

    • 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
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $1410.93changed to$1461.45

    • 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

    $1404.14changed to$1410.93

    • 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 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1489.40changed to$1404.14

    • 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 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1522.31changed to$1489.40

    • 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

    $1514.74changed to$1522.31

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1491.12changed to$1514.74

    • 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 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$1491.12

    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$1,470.51$254.53RVU26D
2026-07-01$1,470.51$254.53RVU26C
2026-04-01$1,470.51$254.53RVU26B
2026-01-01$1,470.51$254.53RVU26A
2025-10-01$1,338.22$283.74RVU25D
2025-07-01$1,338.22$283.74RVU25C
2025-04-01$1,338.22$283.74RVU25B
2025-01-01$1,338.22$283.74RVU25A
2024-10-01$1,433.29$292.04RVU24D
2024-07-01$1,433.29$292.04RVU24C
2024-04-01$1,433.29$292.04RVU24B
2024-03-09$1,433.29$292.04RVU24AR
2024-01-01$1,409.89$287.27RVU24A
2023-10-01$1,535.84$311.92RVU23D
2023-07-01$1,535.84$311.92RVU23C
2023-04-01$1,535.84$311.92RVU23B
2023-01-01$1,535.84$311.92RVU23A
2022-10-01$1,650.21$331.54RVU22D
2022-07-01$1,650.21$331.54RVU22C
2022-04-01$1,650.21$331.54RVU22B
2022-01-01$1,650.21$331.54RVU22A
2021-10-01$1,662.75$329.72RVU21D
2021-07-01$1,662.75$329.72RVU21C
2021-04-01$1,662.75$329.72RVU21B
2021-01-01$1,662.75$329.72RVU21A
2020-10-01$1,533.46$328.17RVU20D
2020-07-01$1,533.46$328.17RVU20C
2020-04-01$1,533.46$328.17RVU20B
2020-01-01$1,533.46$328.17RVU20A
2019-10-01$1,461.45$324.49RVU19D
2019-07-01$1,461.45$324.49RVU19C
2019-04-01$1,461.45$324.49RVU19B
2019-01-01$1,461.45$324.49RVU19A
2018-10-01$1,410.93$324.90RVU18D
2018-07-01$1,410.93$324.90RVU18C
2018-04-01$1,410.93$324.90RVU18B
2018-01-01$1,410.93$324.90RVU18AR1
2017-10-01$1,404.14$324.47RVU17D
2017-07-01$1,404.14$324.47RVU17C
2017-04-01$1,404.14$324.47RVU17B
2017-01-01$1,404.14$324.47RVU17A
2016-10-01$1,489.40$329.45RVU16D
2016-07-01$1,489.40$329.45RVU16C
2016-04-01$1,489.40$329.45RVU16B
2016-01-01$1,489.40$329.45RVU16A
2015-10-01$1,522.31$337.93RVU15D
2015-07-01$1,522.31$337.93RVU15C
2015-04-01$1,514.74$336.25RVU15B
2015-01-01$1,514.74$336.25RVU15A
2014-10-01$1,491.12$328.22RVU14D
2014-07-01$1,491.12$328.22RVU14C
2014-04-01$1,491.12$328.22RVU14B
2014-01-01$1,491.12$328.22RVU14A
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 Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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 Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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