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CPT code 43220: Esophageal dilation, balloon under 30 mm2026 Medicare rate & RVUs in Queens, NY

Reports transoral flexible esophagoscopy with balloon dilation under 30 mm, commonly used to treat an esophageal narrowing such as a benign stricture or ring.

CMS RVU26DEffective Oct 1, 2026One payment locality1.8K Medicare services in 2024

In Queens, NY, Medicare pays $1,126.85 for 43220 in the office and $119.72 when it’s performed in a hospital or facility.

$1,126.85Office (non-facility)
$119.72Hospital or facility
+17.6%vs the national office rate ($957.94)

Check a contract rate as a % of Medicare · 43220 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 43220 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 43220 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 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.

How Queens, NY compares for 43220

Across 109 of 109 payment localities, the office rate for 43220 runs from $829.06 in Arkansas to $1,351.85 in San Benito County, CA. Queens, NY pays $1,126.85. The RVUs are the same everywhere; the geographic indexes change the dollars.

43220 in Queens, NY vs other payment areas
  1. Queens, NY · this page$1,126.85
  2. Manhattan, NY · New York$1,110.42−$16.43
  3. NYC suburbs and Long Island, NY · New York$1,136.65+$9.80
  4. Poughkeepsie and northern NYC suburbs, NY · New York$1,046.68−$80.17
  5. Rest of New York · New York$911.15−$215.70
  6. Los Angeles, CA · California$1,119.48−$7.37
  7. Washington, DC area · District of Columbia$1,119.81−$7.04

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

43220 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$1,007.47$120.47
Chicago, ILIllinois$974.06$117.74
AlaskaAlaska$1,044.07$136.63
AlabamaAlabama$843.65$98.10
ArkansasArkansas$829.06$97.15
ArizonaArizona$929.28$103.64
Bakersfield, CACalifornia$1,040.66$106.80
Chico, CACalifornia$1,039.89$106.04

43220 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.

$829.06

$1,195.87

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
43220 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,044.071
AL$843.651
AR$829.061
AZ$929.281
CA$1,039.89–$1,351.8529
CO$1,013.401
CT$1,029.141
DC$1,119.811
DE$946.781
FL$923.40–$1,007.473
GA$864.12–$974.022
GU$1,075.411
HI$1,075.411
IA$877.551
ID$882.631
IL$885.91–$988.974
IN$888.931
KS$868.751
KY$859.061
LA$855.90–$906.962
MA$1,004.08–$1,131.172
MD$968.49–$1,119.813
ME$883.93–$946.782
MI$882.14–$932.952
MN$977.461
MO$835.70–$915.523
MS$832.781
MT$957.921
NC$895.571
ND$952.781
NE$884.461
NH$993.101
NJ$1,042.72–$1,104.092
NM$886.301
NV$957.371
NY$911.15–$1,136.655
OH$881.091
OK$861.401
OR$951.82–$1,054.892
PA$884.96–$997.042
PR$967.531
RI$987.411
SC$889.441
SD$952.171
TN$873.461
TX$877.75–$1,008.368
UT$904.001
VA$940.35–$1,119.812
VI$967.531
VT$944.811
WA$1,003.57–$1,160.302
WI$914.801
WV$845.861
WY$955.681

See 43220 in every payment locality

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

Office or facility?

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.

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,155

Code
43220
Physician work
1.95
Practice expense
26.47
Malpractice
0.26

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 43220 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work1.95× 1.0642.0748
Practice expense26.47× 1.18231.2875
Malpractice0.26× 1.4420.3749
Total RVUs33.7373
Conversion factor× 33.4009

Office rate, Queens, NY$1126.85

Office: (1.95 × 1.064 + 26.47 × 1.182 + 0.26 × 1.442) × $33.4009 = $1126.85

Facility: (1.95 × 1.064 + 0.96 × 1.182 + 0.26 × 1.442) × $33.4009 = $119.72

Open 43220 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 43220

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

Codes related to 43220
CodeHow it relatesOffice range, Queens, NY
Same family
43214Esophageal dilation, balloon 30 mm or largerSame transoral balloon-dilation approach, for a balloon 30 mm or larger.No office rate
Used instead
43226Esophageal dilation, over guidewireEsophageal dilation performed over a guide wire rather than with this balloon technique.$485.27
43249Esophageal dilation, balloon under 30 mmEGD with balloon dilation under 30 mm when the service includes upper endoscopy.$1,387.58
43233Esophageal dilation, balloon 30 mm or largerEGD with esophageal balloon dilation 30 mm or larger.No office rate
43213Esophageal dilation, retrograde balloon techniqueEsophageal balloon dilation using a retrograde esophagoscopy approach.$1,470.51

How 43220 has changed in Queens, NY

43220 · Office / nonfacility

$1126.85

Effective 2026-10-01

The base rate is $143.30 higher than on 2025-10-01, moving from $983.55 to $1126.85 (14.6%).

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

    $983.55changed to$1126.85

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.00 changed to 1.95
    • Practice expense RVU 23.32 changed to 26.47
    • Malpractice RVU 0.28 changed to 0.26
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1055.43changed to$983.55

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 24.42 changed to 23.32
    • Malpractice RVU 0.27 changed to 0.28

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1038.21changed to$1055.43

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1117.96changed to$1038.21

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 25.01 changed to 24.42
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $1202.29changed to$1117.96

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 26.03 changed to 25.01
    • Malpractice RVU 0.25 changed to 0.27
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1295.89changed to$1202.29

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 27.96 changed to 26.03
    • Malpractice RVU 0.26 changed to 0.25

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $1260.87changed to$1295.89

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 26.53 changed to 27.96
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1277.87changed to$1260.87

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 27.30 changed to 26.53
    • Malpractice RVU 0.28 changed to 0.26
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $1316.98changed to$1277.87

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 28.22 changed to 27.30
    • Malpractice RVU 0.29 changed to 0.28

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $1308.49changed to$1316.98

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 28.11 changed to 28.22
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1379.67changed to$1308.49

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.10 changed to 2.00
    • Practice expense RVU 29.75 changed to 28.11
    • Malpractice RVU 0.30 changed to 0.29
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1400.01changed to$1379.67

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 30.07 changed to 29.75
    • Malpractice RVU 0.32 changed to 0.30

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $1393.04changed to$1400.01

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1217.98changed to$1393.04

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 26.09 changed to 30.07
    • Malpractice RVU 0.30 changed to 0.32
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$1217.98

    Held through RVU14B, RVU14C, RVU14D.

  16. 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$1,126.85$119.72RVU26D
2026-07-01$1,126.85$119.72RVU26C
2026-04-01$1,126.85$119.72RVU26B
2026-01-01$1,126.85$119.72RVU26A
2025-10-01$983.55$130.46RVU25D
2025-07-01$983.55$130.46RVU25C
2025-04-01$983.55$130.46RVU25B
2025-01-01$983.55$130.46RVU25A
2024-10-01$1,055.43$132.97RVU24D
2024-07-01$1,055.43$132.97RVU24C
2024-04-01$1,055.43$132.97RVU24B
2024-03-09$1,055.43$132.97RVU24AR
2024-01-01$1,038.21$130.80RVU24A
2023-10-01$1,117.96$140.05RVU23D
2023-07-01$1,117.96$140.05RVU23C
2023-04-01$1,117.96$140.05RVU23B
2023-01-01$1,117.96$140.05RVU23A
2022-10-01$1,202.29$147.11RVU22D
2022-07-01$1,202.29$147.11RVU22C
2022-04-01$1,202.29$147.11RVU22B
2022-01-01$1,202.29$147.11RVU22A
2021-10-01$1,295.89$148.40RVU21D
2021-07-01$1,295.89$148.40RVU21C
2021-04-01$1,295.89$148.40RVU21B
2021-01-01$1,295.89$148.40RVU21A
2020-10-01$1,260.87$148.46RVU20D
2020-07-01$1,260.87$148.46RVU20C
2020-04-01$1,260.87$148.46RVU20B
2020-01-01$1,260.87$148.46RVU20A
2019-10-01$1,277.87$146.96RVU19D
2019-07-01$1,277.87$146.96RVU19C
2019-04-01$1,277.87$146.96RVU19B
2019-01-01$1,277.87$146.96RVU19A
2018-10-01$1,316.98$148.00RVU18D
2018-07-01$1,316.98$148.00RVU18C
2018-04-01$1,316.98$148.00RVU18B
2018-01-01$1,316.98$148.00RVU18AR1
2017-10-01$1,308.49$148.28RVU17D
2017-07-01$1,308.49$148.28RVU17C
2017-04-01$1,308.49$148.28RVU17B
2017-01-01$1,308.49$148.28RVU17A
2016-10-01$1,379.67$154.90RVU16D
2016-07-01$1,379.67$154.90RVU16C
2016-04-01$1,379.67$154.90RVU16B
2016-01-01$1,379.67$154.90RVU16A
2015-10-01$1,400.01$158.32RVU15D
2015-07-01$1,400.01$158.32RVU15C
2015-04-01$1,393.04$157.53RVU15B
2015-01-01$1,393.04$157.53RVU15A
2014-10-01$1,217.98$153.28RVU14D
2014-07-01$1,217.98$153.28RVU14C
2014-04-01$1,217.98$153.28RVU14B
2014-01-01$1,217.98$153.28RVU14A
2013-10-01Not available in this setting$148.12RVU13D
2013-07-01Not available in this setting$148.12RVU13C
2013-04-01Not available in this setting$148.12RVU13B
2013-01-01Not available in this setting$148.12RVU13AR

Price 43220 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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

Show the CMS file lines behind this rate
RVUs for 43220PPRRVU2026_Oct_nonQPP.csv, line 5,155 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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