CPT code 43214: Esophageal dilation, balloon 30 mm or larger2026 Medicare rate & RVUs in Montana
Reports flexible esophagoscopy with balloon dilation using a balloon 30 mm or larger to treat an esophageal narrowing or obstruction.
In Montana, Medicare pays $168.31 for 43214 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 43214 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 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.
How Montana compares for 43214
Across 109 of 109 payment localities, the facility rate for 43214 runs from $154.50 in Arkansas to $218.94 in Alaska. Montana pays $168.31. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$168.31
- Los Angeles, CA · California$174.73+$6.42
- Washington, DC area · District of Columbia$183.47+$15.16
- Miami, FL · Florida$195.55+$27.24
- Chicago, IL · Illinois$190.95+$22.64
- Manhattan, NY · New York$191.83+$23.52
- Alaska · Alaska$218.94+$50.63
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $156.00 |
| ArkansasArkansas | — | $154.50 |
| ArizonaArizona | — | $164.67 |
| Bakersfield, CACalifornia | — | $167.83 |
| Chico, CACalifornia | — | $166.39 |
| El Centro, CACalifornia | — | $166.47 |
| Fresno, CACalifornia | — | $166.39 |
| Hanford, CACalifornia | — | $166.39 |
| Madera, CACalifornia | — | $166.39 |
| Merced, CACalifornia | — | $166.39 |
| Modesto, CACalifornia | — | $166.39 |
| Napa, CACalifornia | — | $180.07 |
| Oxnard, CACalifornia | — | $172.57 |
| Redding, CACalifornia | — | $166.39 |
| Rest of CaliforniaCalifornia | — | $166.39 |
| Riverside, CACalifornia | — | $171.79 |
| Sacramento, CACalifornia | — | $171.23 |
| Salinas, CACalifornia | — | $170.51 |
| San Diego, CACalifornia | — | $172.01 |
| Marin County, CACalifornia | — | $186.55 |
| San Francisco, CACalifornia | — | $185.98 |
| San Benito County, CACalifornia | — | $190.80 |
| Santa Clara County, CACalifornia | — | $188.48 |
| San Luis Obispo, CACalifornia | — | $168.14 |
| Santa Cruz, CACalifornia | — | $171.68 |
| Santa Maria, CACalifornia | — | $170.46 |
| Santa Rosa, CACalifornia | — | $173.21 |
| Stockton, CACalifornia | — | $166.39 |
| Vallejo, CACalifornia | — | $179.25 |
| Visalia, CACalifornia | — | $166.39 |
| Yuba City, CACalifornia | — | $166.39 |
| ColoradoColorado | — | $168.62 |
| ConnecticutConnecticut | — | $177.20 |
| DelawareDelaware | — | $166.72 |
| Fort Lauderdale, FLFlorida | — | $182.36 |
| Rest of FloridaFlorida | — | $174.95 |
| Atlanta, GAGeorgia | — | $172.68 |
| Rest of GeorgiaGeorgia | — | $167.15 |
| Hawaii, Guam, HIHawaii | — | $166.89 |
| IowaIowa | — | $154.81 |
| IdahoIdaho | — | $156.28 |
| East St. Louis, ILIllinois | — | $182.01 |
| Rest of IllinoisIllinois | — | $174.20 |
| Suburban Chicago, ILIllinois | — | $183.11 |
| IndianaIndiana | — | $156.78 |
| KansasKansas | — | $156.15 |
| KentuckyKentucky | — | $162.40 |
| New Orleans, LALouisiana | — | $168.21 |
| Rest of LouisianaLouisiana | — | $162.95 |
| Metropolitan Boston, MAMassachusetts | — | $178.96 |
| Rest of MassachusettsMassachusetts | — | $168.88 |
| Baltimore area, MDMaryland | — | $177.05 |
| Rest of MarylandMaryland | — | $168.57 |
| Rest of MaineMaine | — | $158.77 |
| Southern Maine, MEMaine | — | $161.81 |
| Detroit, MIMichigan | — | $178.37 |
| Rest of MichiganMichigan | — | $166.95 |
| MinnesotaMinnesota | — | $157.77 |
| Metropolitan Kansas City, MOMissouri | — | $165.47 |
| Metropolitan St. Louis, MOMissouri | — | $166.42 |
| Rest of MissouriMissouri | — | $162.28 |
| MississippiMississippi | — | $158.32 |
| North CarolinaNorth Carolina | — | $159.58 |
| North DakotaNorth Dakota | — | $158.42 |
| NebraskaNebraska | — | $154.82 |
| New HampshireNew Hampshire | — | $167.92 |
| Northern New JerseyNew Jersey | — | $182.98 |
| Rest of New JerseyNew Jersey | — | $178.15 |
| New MexicoNew Mexico | — | $168.32 |
| NevadaNevada | — | $165.59 |
| NYC suburbs and Long Island, NYNew York | — | $197.45 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $180.71 |
| Queens, NYNew York | — | $190.24 |
| Rest of New YorkNew York | — | $161.34 |
| OhioOhio | — | $164.93 |
| OklahomaOklahoma | — | $160.26 |
| Portland, OROregon | — | $170.36 |
| Rest of OregonOregon | — | $163.22 |
| Metropolitan Philadelphia, PAPennsylvania | — | $175.23 |
| Rest of PennsylvaniaPennsylvania | — | $164.08 |
| Puerto RicoPuerto Rico | — | $168.54 |
| Rhode IslandRhode Island | — | $169.99 |
| South CarolinaSouth Carolina | — | $162.74 |
| South DakotaSouth Dakota | — | $157.25 |
| TennesseeTennessee | — | $156.90 |
| Austin, TXTexas | — | $169.02 |
| Beaumont, TXTexas | — | $163.49 |
| Brazoria, TXTexas | — | $165.19 |
| Dallas, TXTexas | — | $166.80 |
| Fort Worth, TXTexas | — | $166.61 |
| Galveston, TXTexas | — | $166.07 |
| Houston, TXTexas | — | $175.22 |
| Rest of TexasTexas | — | $164.64 |
| UtahUtah | — | $164.19 |
| VirginiaVirginia | — | $162.74 |
| Virgin Islands, VIUnited States Virgin Islands | — | $168.54 |
| VermontVermont | — | $159.68 |
| Rest of WashingtonWashington | — | $167.95 |
| King County, WAWashington | — | $180.08 |
| WisconsinWisconsin | — | $155.07 |
| West VirginiaWest Virginia | — | $170.20 |
| WyomingWyoming | — | $164.00 |
43214 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.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,151
- Code
- 43214
- Physician work
- 3.32
- Practice expense
- 1.22
- Malpractice
- 0.50
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.32 | × 1.000 | 3.3200 |
| Practice expense | 1.22 | × 1.000 | 1.2200 |
| Malpractice | 0.50 | × 0.998 | 0.4990 |
| Total RVUs | 5.0390 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Montana$168.31
Facility: (3.32 × 1 + 1.22 × 1 + 0.5 × 0.998) × $33.4009 = $168.31
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%).
How 43214 has changed in Montana
43214 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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, 2014
RVU14A
No ratechanged toNo rate
Held through RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D, RVU26A, RVU26B, RVU26C, RVU26D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $168.31 | RVU26D |
| 2026-07-01 | Not available in this setting | $168.31 | RVU26C |
| 2026-04-01 | Not available in this setting | $168.31 | RVU26B |
| 2026-01-01 | Not available in this setting | $168.31 | RVU26A |
| 2025-10-01 | Not available in this setting | $187.87 | RVU25D |
| 2025-07-01 | Not available in this setting | $187.87 | RVU25C |
| 2025-04-01 | Not available in this setting | $187.87 | RVU25B |
| 2025-01-01 | Not available in this setting | $187.87 | RVU25A |
| 2024-10-01 | Not available in this setting | $191.02 | RVU24D |
| 2024-07-01 | Not available in this setting | $191.02 | RVU24C |
| 2024-04-01 | Not available in this setting | $191.02 | RVU24B |
| 2024-03-09 | Not available in this setting | $191.02 | RVU24AR |
| 2024-01-01 | Not available in this setting | $187.90 | RVU24A |
| 2023-10-01 | Not available in this setting | $193.80 | RVU23D |
| 2023-07-01 | Not available in this setting | $193.80 | RVU23C |
| 2023-04-01 | Not available in this setting | $193.80 | RVU23B |
| 2023-01-01 | Not available in this setting | $193.80 | RVU23A |
| 2022-10-01 | Not available in this setting | $195.17 | RVU22D |
| 2022-07-01 | Not available in this setting | $195.17 | RVU22C |
| 2022-04-01 | Not available in this setting | $195.17 | RVU22B |
| 2022-01-01 | Not available in this setting | $195.17 | RVU22A |
| 2021-10-01 | Not available in this setting | $195.41 | RVU21D |
| 2021-07-01 | Not available in this setting | $195.41 | RVU21C |
| 2021-04-01 | Not available in this setting | $195.41 | RVU21B |
| 2021-01-01 | Not available in this setting | $195.41 | RVU21A |
| 2020-10-01 | Not available in this setting | $205.16 | RVU20D |
| 2020-07-01 | Not available in this setting | $205.16 | RVU20C |
| 2020-04-01 | Not available in this setting | $205.16 | RVU20B |
| 2020-01-01 | Not available in this setting | $205.16 | RVU20A |
| 2019-10-01 | Not available in this setting | $212.87 | RVU19D |
| 2019-07-01 | Not available in this setting | $212.87 | RVU19C |
| 2019-04-01 | Not available in this setting | $212.87 | RVU19B |
| 2019-01-01 | Not available in this setting | $212.87 | RVU19A |
| 2018-10-01 | Not available in this setting | $214.40 | RVU18D |
| 2018-07-01 | Not available in this setting | $214.40 | RVU18C |
| 2018-04-01 | Not available in this setting | $214.40 | RVU18B |
| 2018-01-01 | Not available in this setting | $214.40 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $210.16 | RVU17D |
| 2017-07-01 | Not available in this setting | $210.16 | RVU17C |
| 2017-04-01 | Not available in this setting | $210.16 | RVU17B |
| 2017-01-01 | Not available in this setting | $210.16 | RVU17A |
| 2016-10-01 | Not available in this setting | $210.75 | RVU16D |
| 2016-07-01 | Not available in this setting | $210.75 | RVU16C |
| 2016-04-01 | Not available in this setting | $210.75 | RVU16B |
| 2016-01-01 | Not available in this setting | $210.75 | RVU16A |
| 2015-10-01 | Not available in this setting | $214.63 | RVU15D |
| 2015-07-01 | Not available in this setting | $214.63 | RVU15C |
| 2015-04-01 | Not available in this setting | $213.56 | RVU15B |
| 2015-01-01 | Not available in this setting | $213.56 | RVU15A |
| 2014-10-01 | Not available in this setting | $206.31 | RVU14D |
| 2014-07-01 | Not available in this setting | $206.31 | RVU14C |
| 2014-04-01 | Not available in this setting | $206.31 | RVU14B |
| 2014-01-01 | Not available in this setting | $206.31 | 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
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
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