CPT code 43220: Esophageal dilation, balloon under 30 mm2026 Medicare rate & RVUs in California
Reports transoral flexible esophagoscopy with balloon dilation under 30 mm, commonly used to treat an esophageal narrowing such as a benign stricture or ring.
Medicare pays $1,039.89–$1,351.85 for 43220 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
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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On this page 9 sections
What 43220 covers
A gastroenterologist or other endoscopist passes a flexible scope through the mouth to examine the esophagus and dilate a narrowing with a balloon smaller than 30 mm. Typical situations include treatment of a benign esophageal stricture or ring in an outpatient endoscopy unit or hospital. The procedure is limited to esophagoscopy; a service that examines the stomach or duodenum may fall under an EGD code instead.
Report the code when the documentation supports transoral flexible esophagoscopy and balloon dilation, including the treated site and balloon diameter. It has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS applies endoscopy-family pricing. 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.
Where 43220 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$1039.89 to $1351.85
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $1,040.66 | $106.80 |
| Chico, CA | $1,039.89 | $106.04 |
| El Centro, CA | $1,039.93 | $106.08 |
| Fresno, CA | $1,039.89 | $106.04 |
| Hanford, CA | $1,039.89 | $106.04 |
| Los Angeles, CA | $1,119.48 | $111.50 |
| Madera, CA | $1,039.89 | $106.04 |
| Marin County, CA | $1,321.92 | $120.52 |
| Merced, CA | $1,039.89 | $106.04 |
| Modesto, CA | $1,039.89 | $106.04 |
| Napa, CA | $1,238.92 | $115.91 |
| Oxnard, CA | $1,117.40 | $110.27 |
| Redding, CA | $1,039.89 | $106.04 |
| Rest of California | $1,039.89 | $106.04 |
| Riverside, CA | $1,042.71 | $108.85 |
| Sacramento, CA | $1,100.36 | $109.42 |
| Salinas, CA | $1,096.50 | $108.97 |
| San Benito County, CA | $1,351.85 | $123.19 |
| San Diego, CA | $1,129.20 | $110.14 |
| San Francisco, CA | $1,321.62 | $120.22 |
| San Luis Obispo, CA | $1,077.91 | $107.42 |
| Santa Clara County, CA | $1,350.65 | $121.98 |
| Santa Cruz, CA | $1,145.36 | $110.11 |
| Santa Maria, CA | $1,102.50 | $109.00 |
| Santa Rosa, CA | $1,157.44 | $111.12 |
| Stockton, CA | $1,039.89 | $106.04 |
| Vallejo, CA | $1,238.49 | $115.48 |
| Visalia, CA | $1,039.89 | $106.04 |
| Yuba City, CA | $1,039.89 | $106.04 |
How the 43220 rate is calculated
Each of 43220’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 · 43220
RVUs × geographic indexes × conversion factor
Work1.95
1.95 RVUs× 1.000 GPCI
Practice expense26.47
26.47 RVUs× 1.000 GPCI
Malpractice0.26
0.26 RVUs× 1.000 GPCI
Adjusted RVUs
28.6800
Conversion factor
$33.4009
Medicare rate
$957.94
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43220
The CMS indicators that decide how 43220 is paid alongside other services.
CMS payment indicators · 43220
Esophageal dilation, balloon under 30 mm
| 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
43220 without 51 · national office
$957.94
Esophageal dilation, balloon under 30 mm
43220-51 · Second procedure: 50%
$478.97
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%).
43220 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43214Esophageal dilationBalloon 30 mm or larger
- The balloon diameter distinguishes these transoral esophagoscopy codes: 43220 is for under 30 mm, while 43214 is for 30 mm or larger.
- 43226Esophageal dilationOver guidewire
- 43226 describes dilation over a guide wire. Use 43220 when the documented service uses balloon dilation under 30 mm.
- 43249Esophageal dilationBalloon under 30 mm
- 43249 is an EGD with balloon dilation under 30 mm. 43220 is for esophagoscopy; distinguish them by the scope examination documented.
- 43213Esophageal dilationRetrograde balloon technique
- 43213 involves retrograde esophagoscopy for balloon dilation. 43220 is the transoral approach.
43220 billing questions
How does this differ from 43214?
Both describe transoral flexible esophagoscopy with balloon dilation. Use 43220 for a balloon under 30 mm; 43214 is for a balloon 30 mm or larger.
When would 43226 be a better fit?
43226 describes esophageal dilation over a guide wire. Choose based on the documented dilation technique, not simply because the same narrowing was treated.
Should an EGD dilation code be used instead?
Use an EGD code when the documented service is an upper endoscopy that includes examination beyond the esophagus. For EGD balloon dilation under 30 mm, compare 43249; for a balloon 30 mm or larger, compare 43233.
What should the procedure note include?
Document the transoral flexible esophagoscopy, the narrowing and its location, the balloon dilation performed, and the balloon diameter.
Can modifier 50 or an assistant-at-surgery claim be reported?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for the service; 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
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