CPT code 43226: Esophageal dilation, over guidewire2026 Medicare rate & RVUs
Reports flexible transoral esophagoscopy with guidewire placement and dilation over the wire to treat an esophageal narrowing.
Medicare pays $415.17 for 43226 nationally in the office and $117.24 in a hospital or facility. Local office rates run $362.76–$563.61.
Medicare rate · 43226
Esophageal dilation, over guidewire
- Work RVUs
- 2.18
- Total RVUs
- 12.43
- Global days
- 000
National rate · 2026
$415.17
Office setting, before claim adjustments.
See every locality for 43226 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 10 sections
What 43226 covers
A gastroenterologist or other qualified endoscopist uses a flexible scope passed through the mouth to examine the esophagus, place a guidewire, and dilate a narrowed segment over the wire. Common indications include an esophageal stricture causing difficulty swallowing. The service may be performed in an endoscopy center or hospital, and sometimes in an office setting.
Select this code when the dilation is performed over a guidewire; balloon dilation and retrograde approaches have distinct codes. Document the narrowing, the guidewire-assisted technique, and the dilation performed. The 0-day global period includes routine same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery reporting 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 43226 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$362.76 to $563.61
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $368.66 | $107.97 |
| Alaska | $467.65 | $150.35 |
| Arizona | $403.20 | $114.50 |
| Arkansas | $362.76 | $106.84 |
| Atlanta, GA | $423.09 | $120.39 |
| Austin, TX | $433.11 | $117.89 |
| Bakersfield, CA | $443.57 | $117.03 |
| Baltimore area, MD | $443.30 | $123.62 |
| Beaumont, TX | $384.59 | $113.47 |
| Brazoria, TX | $410.14 | $114.88 |
| Chicago, IL | $432.91 | $133.48 |
| Chico, CA | $442.54 | $116.01 |
| Colorado | $434.56 | $117.55 |
| Connecticut | $444.59 | $123.71 |
| Dallas, TX | $412.80 | $116.06 |
| Delaware | $410.36 | $116.00 |
| Detroit, MI | $411.86 | $124.35 |
| East St. Louis, IL | $400.94 | $126.84 |
| El Centro, CA | $442.60 | $116.07 |
| Fort Lauderdale, FL | $429.18 | $127.37 |
| Fort Worth, TX | $409.65 | $115.89 |
| Fresno, CA | $442.54 | $116.01 |
| Galveston, TX | $411.38 | $115.52 |
| Hanford, CA | $442.54 | $116.01 |
| Hawaii, Guam, HI | $455.37 | $116.61 |
| Houston, TX | $417.96 | $122.11 |
| Idaho | $382.41 | $108.31 |
| Indiana | $384.88 | $108.69 |
| Iowa | $379.84 | $107.23 |
| Kansas | $377.50 | $108.16 |
| Kentucky | $377.48 | $112.62 |
| King County, WA | $491.60 | $126.03 |
| Los Angeles, CA | $474.57 | $122.11 |
| Madera, CA | $442.54 | $116.01 |
| Manhattan, NY | $480.39 | $134.19 |
| Marin County, CA | $551.02 | $130.93 |
| Merced, CA | $442.54 | $116.01 |
| Metropolitan Boston, MA | $480.92 | $125.19 |
| Metropolitan Kansas City, MO | $394.75 | $114.98 |
| Metropolitan Philadelphia, PA | $432.35 | $122.20 |
| Metropolitan St. Louis, MO | $399.34 | $115.71 |
| Miami, FL | $447.10 | $136.95 |
| Minnesota | $416.29 | $109.71 |
| Mississippi | $366.12 | $109.60 |
| Modesto, CA | $442.54 | $116.01 |
| Montana | $415.15 | $117.21 |
| Napa, CA | $518.89 | $126.21 |
| Nebraska | $382.26 | $107.26 |
| Nevada | $413.50 | $115.26 |
| New Hampshire | $427.21 | $117.06 |
| New Mexico | $390.17 | $116.96 |
| New Orleans, LA | $397.32 | $116.96 |
| North Carolina | $388.70 | $110.73 |
| North Dakota | $408.03 | $110.09 |
| Northern New Jersey | $473.43 | $127.83 |
| NYC suburbs and Long Island, NY | $492.57 | $138.33 |
| Ohio | $386.53 | $114.51 |
| Oklahoma | $377.15 | $111.09 |
| Oxnard, CA | $472.80 | $120.64 |
| Portland, OR | $449.93 | $118.92 |
| Poughkeepsie and northern NYC suburbs, NY | $452.36 | $126.12 |
| Puerto Rico | $418.63 | $117.41 |
| Queens, NY | $485.27 | $133.11 |
| Redding, CA | $442.54 | $116.01 |
| Rest of California | $442.54 | $116.01 |
| Rest of Florida | $406.69 | $121.86 |
| Rest of Georgia | $381.81 | $116.05 |
| Rest of Illinois | $393.20 | $121.19 |
| Rest of Louisiana | $376.68 | $113.01 |
| Rest of Maine | $384.20 | $110.10 |
| Rest of Maryland | $418.88 | $117.37 |
| Rest of Massachusetts | $431.41 | $117.68 |
| Rest of Michigan | $387.99 | $115.97 |
| Rest of Missouri | $369.27 | $112.45 |
| Rest of New Jersey | $449.64 | $124.30 |
| Rest of New York | $395.09 | $112.05 |
| Rest of Oregon | $410.28 | $113.54 |
| Rest of Pennsylvania | $387.42 | $113.92 |
| Rest of Texas | $397.16 | $114.42 |
| Rest of Washington | $430.75 | $117.03 |
| Rhode Island | $426.16 | $118.39 |
| Riverside, CA | $446.43 | $119.89 |
| Sacramento, CA | $466.06 | $119.56 |
| Salinas, CA | $464.37 | $119.07 |
| San Benito County, CA | $563.61 | $133.99 |
| San Diego, CA | $476.60 | $120.26 |
| San Francisco, CA | $550.61 | $130.52 |
| San Luis Obispo, CA | $456.75 | $117.40 |
| Santa Clara County, CA | $561.94 | $132.32 |
| Santa Cruz, CA | $482.14 | $120.15 |
| Santa Maria, CA | $466.47 | $119.07 |
| Santa Rosa, CA | $487.09 | $121.23 |
| South Carolina | $388.26 | $112.97 |
| South Dakota | $407.19 | $109.25 |
| Southern Maine, ME | $407.76 | $112.51 |
| Stockton, CA | $442.54 | $116.01 |
| Suburban Chicago, IL | $433.88 | $127.90 |
| Tennessee | $379.55 | $108.72 |
| Utah | $394.13 | $114.07 |
| Vallejo, CA | $518.30 | $125.62 |
| Vermont | $405.93 | $110.97 |
| Virgin Islands, VI | $418.63 | $117.41 |
| Virginia | $406.02 | $113.15 |
| Visalia, CA | $442.54 | $116.01 |
| Washington, DC area | $479.26 | $128.29 |
| West Virginia | $377.08 | $118.18 |
| Wisconsin | $392.98 | $107.56 |
| Wyoming | $412.05 | $114.11 |
| Yuba City, CA | $442.54 | $116.01 |
43226 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.
$362.76
$503.08
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $467.65 | 1 |
| AL | $368.66 | 1 |
| AR | $362.76 | 1 |
| AZ | $403.20 | 1 |
| CA | $442.54–$563.61 | 29 |
| CO | $434.56 | 1 |
| CT | $444.59 | 1 |
| DC | $479.26 | 1 |
| DE | $410.36 | 1 |
| FL | $406.69–$447.10 | 3 |
| GA | $381.81–$423.09 | 2 |
| GU | $455.37 | 1 |
| HI | $455.37 | 1 |
| IA | $379.84 | 1 |
| ID | $382.41 | 1 |
| IL | $393.20–$433.88 | 4 |
| IN | $384.88 | 1 |
| KS | $377.50 | 1 |
| KY | $377.48 | 1 |
| LA | $376.68–$397.32 | 2 |
| MA | $431.41–$480.92 | 2 |
| MD | $418.88–$479.26 | 3 |
| ME | $384.20–$407.76 | 2 |
| MI | $387.99–$411.86 | 2 |
| MN | $416.29 | 1 |
| MO | $369.27–$399.34 | 3 |
| MS | $366.12 | 1 |
| MT | $415.15 | 1 |
| NC | $388.70 | 1 |
| ND | $408.03 | 1 |
| NE | $382.26 | 1 |
| NH | $427.21 | 1 |
| NJ | $449.64–$473.43 | 2 |
| NM | $390.17 | 1 |
| NV | $413.50 | 1 |
| NY | $395.09–$492.57 | 5 |
| OH | $386.53 | 1 |
| OK | $377.15 | 1 |
| OR | $410.28–$449.93 | 2 |
| PA | $387.42–$432.35 | 2 |
| PR | $418.63 | 1 |
| RI | $426.16 | 1 |
| SC | $388.26 | 1 |
| SD | $407.19 | 1 |
| TN | $379.55 | 1 |
| TX | $384.59–$433.11 | 8 |
| UT | $394.13 | 1 |
| VA | $406.02–$479.26 | 2 |
| VI | $418.63 | 1 |
| VT | $405.93 | 1 |
| WA | $430.75–$491.60 | 2 |
| WI | $392.98 | 1 |
| WV | $377.08 | 1 |
| WY | $412.05 | 1 |
How the 43226 rate is calculated
Each of 43226’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 · 43226
RVUs × geographic indexes × conversion factor
Work2.18
2.18 RVUs× 1.000 GPCI
Practice expense9.89
9.89 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
12.4300
Conversion factor
$33.4009
Medicare rate
$415.17
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43226
The CMS indicators that decide how 43226 is paid alongside other services.
CMS payment indicators · 43226
Esophageal dilation, over guidewire
| 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
43226 without 51 · national office
$415.17
Esophageal dilation, over guidewire
43226-51 · Second procedure: 50%
$207.59
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%).
43226 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43220Esophageal dilationBalloon under 30 mm
- 43226 involves dilation over a guidewire. Choose 43220 for balloon dilation under 30 mm.
- 43214Esophageal dilationBalloon 30 mm or larger
- 43226 describes guidewire-assisted dilation; 43214 is the esophageal balloon-dilation code for a diameter of 30 mm or larger.
- 43233Esophageal dilationBalloon 30 mm or larger
- 43233 reports upper endoscopy with balloon dilation at 30 mm or larger. 43226 is the guidewire-dilation service performed through flexible esophagoscopy.
43226 billing questions
When should this code be chosen over balloon-dilation codes?
Use 43226 when the esophagus is dilated over a guidewire. Balloon dilation is reported with a code specific to the balloon method and size.
Can the diagnostic esophagoscopy be billed separately?
The scope examination used to perform the dilation is part of the reported service; do not separately report a diagnostic examination for that same work.
What documentation supports 43226?
Document the esophageal narrowing, the flexible transoral approach, guidewire placement, and dilation over the wire.
Does modifier 50 apply if the narrowing involves both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; report the service performed without modifier 50.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this 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
Fee sheets · Coming soon
Put 43226 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist