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CPT code 43214: Esophageal dilation, balloon 30 mm or larger2026 Medicare rate & RVUs

Reports flexible esophagoscopy with balloon dilation using a balloon 30 mm or larger to treat an esophageal narrowing or obstruction.

CMS RVU26DEffective Oct 1, 2026109 payment localities262 Medicare services in 2024

Medicare pays $168.34 for 43214 nationally in a facility.

Medicare rate · 43214

Esophageal dilation, balloon 30 mm or larger

Office or facility?

Work RVUs
3.32
Total RVUs
5.04
Global days
000

National rate · 2026

$168.34

Facility setting, before claim adjustments.

See every locality for 43214 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 43214 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43214 covers

A gastroenterologist or other qualified endoscopist advances a flexible scope through the mouth to examine the esophagus and dilates a narrowed area with a balloon measuring 30 mm or larger. This approach may be used for a tight esophageal narrowing or for pneumatic dilation in a patient with achalasia. The balloon diameter is the key distinction from smaller-balloon esophagoscopy codes; an upper endoscopy that also examines the stomach or duodenum is a different service.

Report the code when the documented procedure supports flexible esophagoscopy and dilation with the required balloon size. The operative report should identify the treated esophageal site, dilation technique, and balloon diameter. Related endoscopies performed together are subject to endoscopy-family pricing. The code has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate. Medicare does not pay for an assistant at surgery, and co-surgeon and team-surgery billing 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.

Where 43214 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43214 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$156.00
AlaskaUnavailable$218.94
ArizonaUnavailable$164.67
ArkansasUnavailable$154.50
Atlanta, GAUnavailable$172.68
Austin, TXUnavailable$169.02
Bakersfield, CAUnavailable$167.83
Baltimore area, MDUnavailable$177.05
Beaumont, TXUnavailable$163.49
Brazoria, TXUnavailable$165.19

43214 rates by state

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

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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.

View every state and territory as a table
43214 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43214 rate is calculated

Each of 43214’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 · 43214

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.32

3.32 RVUs× 1.000 GPCI

Practice expense1.22

1.22 RVUs× 1.000 GPCI

Malpractice0.50

0.50 RVUs× 1.000 GPCI

Adjusted RVUs

5.0400

Conversion factor

$33.4009

Medicare rate

$168.34

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 43214

The CMS indicators that decide how 43214 is paid alongside other services.

CMS payment indicators · 43214

Esophageal dilation, balloon 30 mm or larger

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

43214 without 51 · national facility

$168.34

Esophageal dilation, balloon 30 mm or larger

43214-51 · Second procedure: 50%

$84.17

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

43214 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43214

    Esophageal dilation, balloon 30 mm or larger3.32 wRVU

    Not priced

  • 43220

    Esophageal dilation, balloon under 30 mm1.95 wRVU

    $957.94

  • 43233

    Esophageal dilation, balloon 30 mm or larger3.97 wRVU

    Not priced

  • 43226

    Esophageal dilation, over guidewire2.18 wRVU

    $415.17

How to choose

43220Esophageal dilationBalloon under 30 mm
Choose 43220 for balloon dilation under 30 mm. This code is for a balloon 30 mm or larger.
43233Esophageal dilationBalloon 30 mm or larger
43233 describes EGD with large-balloon esophageal dilation. Choose based on whether the service includes the broader upper endoscopic examination rather than esophagoscopy alone.
43226Esophageal dilationOver guidewire
43226 describes esophageal endoscopic dilation by a different technique. This code specifically requires balloon dilation with a diameter of 30 mm or larger.

Codes related to 43214

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

Codes related to 43214
CodeHow it relatesNational office range
Same family
43220Esophageal dilation, balloon under 30 mmEsophagoscopy with balloon dilation using a balloon under 30 mm.$829.06–$1,351.85
Used instead
43233Esophageal dilation, balloon 30 mm or largerEGD with large-balloon esophageal dilation when the examination includes the upper gastrointestinal tract.No office rate
43226Esophageal dilation, over guidewireEsophageal endoscopic dilation reported for a different dilation technique.$362.76–$563.61

43214 billing questions

How does this code differ from 43220?

The balloon diameter distinguishes the services: this code is for a balloon 30 mm or larger, while 43220 is for a balloon under 30 mm.

Can this be reported for an EGD that includes stomach examination?

Use the EGD dilation code when the service includes examination of the stomach or duodenum. This code describes esophagoscopy with large-balloon dilation.

What documentation supports the balloon-size selection?

Document the esophageal treatment site, the dilation performed, and the balloon diameter. The record should support use of a balloon measuring at least 30 mm.

Is same-day care included in the payment?

Yes. The 0-day global period includes same-day preoperative and postoperative care.

Can modifier 50 or an assistant-at-surgery modifier be used?

Modifier 50 is inappropriate for this service. Medicare does not pay for an assistant at surgery for this code.

What happens when another related endoscopy is performed during the same session?

CMS endoscopy-family pricing applies when related endoscopies are performed together. Review the combined procedures under the applicable endoscopy-family pricing rules.

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 43214PPRRVU2026_Oct_nonQPP.csv, line 5,151 (RVU26D)

Open CMS sourceHow we calculate rates

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