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CPT code 43213: Esophageal dilation, retrograde balloon technique2026 Medicare rate & RVUs in Puerto Rico

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 Puerto Rico, Medicare pays $1,265.76 for 43213 in the office and $225.70 when it’s performed in a hospital or facility.

$1,265.76Office (non-facility)
$225.70Hospital or facility
+0.9%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $1,265.76. The RVUs are the same everywhere; the geographic indexes change the dollars.

43213 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$1,265.76
  2. Los Angeles, CA · California$1,450.72+$184.96
  3. Washington, DC area · District of Columbia$1,457.32+$191.56
  4. Miami, FL · Florida$1,332.75+$66.99
  5. Chicago, IL · Illinois$1,289.64+$23.88
  6. Manhattan, NY · New York$1,452.11+$186.35
  7. Alaska · Alaska$1,389.75+$123.99

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

Every other payment area

43213 in every other Medicare payment locality
Payment localityOfficeFacility
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

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 43213 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work4.51× 1.0004.5100
Practice expense32.37× 1.01132.7261
Malpractice0.67× 0.9850.6600
Total RVUs37.8960
Conversion factor× 33.4009

Office rate, Puerto Rico$1265.76

Office: (4.51 × 1 + 32.37 × 1.011 + 0.67 × 0.985) × $33.4009 = $1265.76

Facility: (4.51 × 1 + 1.57 × 1.011 + 0.67 × 0.985) × $33.4009 = $225.70

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, Puerto Rico
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.$967.53
43226Esophageal dilation, over guidewireDescribes esophageal dilation over a guide wire, a different dilation technique.$418.63

How 43213 has changed in Puerto Rico

43213 · Office / nonfacility

$1265.76

Effective 2026-10-01

The base rate is $128.29 higher than on 2025-10-01, moving from $1137.47 to $1265.76 (11.3%).

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

    $1137.47changed to$1265.76

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1217.45changed to$1137.47

    • 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

    $1197.58changed to$1217.45

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1277.72changed to$1197.58

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $1269.41changed to$1277.72

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $1346.05changed to$1269.41

    • 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 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $1357.94changed to$1346.05

    • 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.

  8. January 1, 2021

    RVU21A

    $1271.08changed to$1357.94

    • 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 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $1226.88changed to$1271.08

    • 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 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $1184.21changed to$1226.88

    • 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.

  11. January 1, 2018

    RVU18AR1

    $1022.27changed to$1184.21

    • 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 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $917.68changed to$1022.27

    • 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 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $935.05changed to$917.68

    • 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.

  14. July 1, 2015

    RVU15C

    $930.40changed to$935.05

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $908.97changed to$930.40

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    No ratechanged to$908.97

    Held through RVU14B, RVU14C, RVU14D.

  17. 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$1,265.76$225.70RVU26D
2026-07-01$1,265.76$225.70RVU26C
2026-04-01$1,265.76$225.70RVU26B
2026-01-01$1,265.76$225.70RVU26A
2025-10-01$1,137.47$248.88RVU25D
2025-07-01$1,137.47$248.88RVU25C
2025-04-01$1,137.47$248.88RVU25B
2025-01-01$1,137.47$248.88RVU25A
2024-10-01$1,217.45$255.74RVU24D
2024-07-01$1,217.45$255.74RVU24C
2024-04-01$1,217.45$255.74RVU24B
2024-03-09$1,217.45$255.74RVU24AR
2024-01-01$1,197.58$251.57RVU24A
2023-10-01$1,277.72$259.80RVU23D
2023-07-01$1,269.41$259.58RVU23C
2023-04-01$1,269.41$259.58RVU23B
2023-01-01$1,269.41$259.58RVU23A
2022-10-01$1,346.05$263.63RVU22D
2022-07-01$1,346.05$263.63RVU22C
2022-04-01$1,346.05$263.63RVU22B
2022-01-01$1,346.05$263.63RVU22A
2021-10-01$1,357.94$263.74RVU21D
2021-07-01$1,357.94$263.74RVU21C
2021-04-01$1,357.94$263.74RVU21B
2021-01-01$1,357.94$263.74RVU21A
2020-10-01$1,271.08$270.31RVU20D
2020-07-01$1,271.08$270.31RVU20C
2020-04-01$1,271.08$270.31RVU20B
2020-01-01$1,271.08$270.31RVU20A
2019-10-01$1,226.88$272.78RVU19D
2019-07-01$1,226.88$272.78RVU19C
2019-04-01$1,226.88$272.78RVU19B
2019-01-01$1,226.88$272.78RVU19A
2018-10-01$1,184.21$272.84RVU18D
2018-07-01$1,184.21$272.84RVU18C
2018-04-01$1,184.21$272.84RVU18B
2018-01-01$1,184.21$272.84RVU18AR1
2017-10-01$1,022.27$252.11RVU17D
2017-07-01$1,022.27$252.11RVU17C
2017-04-01$1,022.27$252.11RVU17B
2017-01-01$1,022.27$252.11RVU17A
2016-10-01$917.68$235.64RVU16D
2016-07-01$917.68$235.64RVU16C
2016-04-01$917.68$235.64RVU16B
2016-01-01$917.68$235.64RVU16A
2015-10-01$935.05$238.64RVU15D
2015-07-01$935.05$238.64RVU15C
2015-04-01$930.40$237.45RVU15B
2015-01-01$930.40$237.45RVU15A
2014-10-01$908.97$236.68RVU14D
2014-07-01$908.97$236.68RVU14C
2014-04-01$908.97$236.68RVU14B
2014-01-01$908.97$236.68RVU14A
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 Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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