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

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 Puerto Rico, Medicare pays $967.53 for 43220 in the office and $106.10 when it’s performed in a hospital or facility.

$967.53Office (non-facility)
$106.10Hospital or facility
+1.0%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $967.53. The RVUs are the same everywhere; the geographic indexes change the dollars.

43220 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$967.53
  2. Los Angeles, CA · California$1,119.48+$151.95
  3. Washington, DC area · District of Columbia$1,119.81+$152.28
  4. Miami, FL · Florida$1,007.47+$39.94
  5. Chicago, IL · Illinois$974.06+$6.53
  6. Manhattan, NY · New York$1,110.42+$142.89
  7. Alaska · Alaska$1,044.07+$76.54

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

43220 in every other Medicare payment locality
Payment localityOfficeFacility
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
El Centro, CACalifornia$1,039.93$106.08
Fresno, CACalifornia$1,039.89$106.04
Hanford, 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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 43220 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.95× 1.0001.9500
Practice expense26.47× 1.01126.7612
Malpractice0.26× 0.9850.2561
Total RVUs28.9673
Conversion factor× 33.4009

Office rate, Puerto Rico$967.53

Office: (1.95 × 1 + 26.47 × 1.011 + 0.26 × 0.985) × $33.4009 = $967.53

Facility: (1.95 × 1 + 0.96 × 1.011 + 0.26 × 0.985) × $33.4009 = $106.10

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, Puerto Rico
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.$418.63
43249Esophageal dilation, balloon under 30 mmEGD with balloon dilation under 30 mm when the service includes upper endoscopy.$1,192.16
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.$1,265.76

How 43220 has changed in Puerto Rico

43220 · Office / nonfacility

$967.53

Effective 2026-10-01

The base rate is $134.34 higher than on 2025-10-01, moving from $833.19 to $967.53 (16.1%).

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

    $833.19changed to$967.53

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $893.97changed to$833.19

    • 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

    $879.38changed to$893.97

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $931.08changed to$879.38

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 25.01 changed to 24.42
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $924.44changed to$931.08

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $985.75changed to$924.44

    • 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
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $1062.15changed to$985.75

    • 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.

  8. January 1, 2021

    RVU21A

    $1046.57changed to$1062.15

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 26.53 changed to 27.96
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $1072.82changed to$1046.57

    • 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
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $1105.35changed to$1072.82

    • 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.

  11. January 1, 2018

    RVU18AR1

    $942.02changed to$1105.35

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 28.11 changed to 28.22
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $829.29changed to$942.02

    • 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 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $840.60changed to$829.29

    • 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.

  14. July 1, 2015

    RVU15C

    $836.41changed to$840.60

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $724.90changed to$836.41

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    No ratechanged to$724.90

    Held through RVU14B, RVU14C, RVU14D.

  17. 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$967.53$106.10RVU26D
2026-07-01$967.53$106.10RVU26C
2026-04-01$967.53$106.10RVU26B
2026-01-01$967.53$106.10RVU26A
2025-10-01$833.19$114.30RVU25D
2025-07-01$833.19$114.30RVU25C
2025-04-01$833.19$114.30RVU25B
2025-01-01$833.19$114.30RVU25A
2024-10-01$893.97$116.63RVU24D
2024-07-01$893.97$116.63RVU24C
2024-04-01$893.97$116.63RVU24B
2024-03-09$893.97$116.63RVU24AR
2024-01-01$879.38$114.73RVU24A
2023-10-01$931.08$117.77RVU23D
2023-07-01$924.44$117.59RVU23C
2023-04-01$924.44$117.59RVU23B
2023-01-01$924.44$117.59RVU23A
2022-10-01$985.75$119.60RVU22D
2022-07-01$985.75$119.60RVU22C
2022-04-01$985.75$119.60RVU22B
2022-01-01$985.75$119.60RVU22A
2021-10-01$1,062.15$120.23RVU21D
2021-07-01$1,062.15$120.23RVU21C
2021-04-01$1,062.15$120.23RVU21B
2021-01-01$1,062.15$120.23RVU21A
2020-10-01$1,046.57$122.92RVU20D
2020-07-01$1,046.57$122.92RVU20C
2020-04-01$1,046.57$122.92RVU20B
2020-01-01$1,046.57$122.92RVU20A
2019-10-01$1,072.82$123.80RVU19D
2019-07-01$1,072.82$123.80RVU19C
2019-04-01$1,072.82$123.80RVU19B
2019-01-01$1,072.82$123.80RVU19A
2018-10-01$1,105.35$124.39RVU18D
2018-07-01$1,105.35$124.39RVU18C
2018-04-01$1,105.35$124.39RVU18B
2018-01-01$1,105.35$124.39RVU18AR1
2017-10-01$942.02$114.40RVU17D
2017-07-01$942.02$114.40RVU17C
2017-04-01$942.02$114.40RVU17B
2017-01-01$942.02$114.40RVU17A
2016-10-01$829.29$109.13RVU16D
2016-07-01$829.29$109.13RVU16C
2016-04-01$829.29$109.13RVU16B
2016-01-01$829.29$109.13RVU16A
2015-10-01$840.60$110.50RVU15D
2015-07-01$840.60$110.50RVU15C
2015-04-01$836.41$109.95RVU15B
2015-01-01$836.41$109.95RVU15A
2014-10-01$724.90$109.37RVU14D
2014-07-01$724.90$109.37RVU14C
2014-04-01$724.90$109.37RVU14B
2014-01-01$724.90$109.37RVU14A
2013-10-01Not available in this setting$106.14RVU13D
2013-07-01Not available in this setting$106.14RVU13C
2013-04-01Not available in this setting$106.14RVU13B
2013-01-01Not available in this setting$106.14RVU13AR

Price 43220 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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