CPT code 43214: Esophageal dilation, balloon 30 mm or larger2026 Medicare rate & RVUs in Missouri
Reports flexible esophagoscopy with balloon dilation using a balloon 30 mm or larger to treat an esophageal narrowing or obstruction.
CMS doesn’t publish an office rate for 43214 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $165.47 |
| Metropolitan St. Louis, MO | Unavailable | $166.42 |
| Rest of Missouri | Unavailable | $162.28 |
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
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
| 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
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%).
43214 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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