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CPT code 43226: Esophageal dilation, over guidewire2026 Medicare rate & RVUs in North Carolina

Reports flexible transoral esophagoscopy with guidewire placement and dilation over the wire to treat an esophageal narrowing.

CMS RVU26DEffective Oct 1, 2026One payment locality1.4K Medicare services in 2024

In North Carolina, Medicare pays $388.70 for 43226 in the office and $110.73 when it’s performed in a hospital or facility.

$388.70Office (non-facility)
$110.73Hospital or facility
−6.4%vs the national office rate ($415.17)

Check a contract rate as a % of Medicare · 43226 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 43226 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 43226 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 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.

How North Carolina compares for 43226

Across 109 of 109 payment localities, the office rate for 43226 runs from $362.76 in Arkansas to $563.61 in San Benito County, CA. North Carolina pays $388.70. The RVUs are the same everywhere; the geographic indexes change the dollars.

43226 in North Carolina vs other payment areas
  1. North Carolina · this page$388.70
  2. Los Angeles, CA · California$474.57+$85.87
  3. Washington, DC area · District of Columbia$479.26+$90.56
  4. Miami, FL · Florida$447.10+$58.40
  5. Chicago, IL · Illinois$432.91+$44.21
  6. Manhattan, NY · New York$480.39+$91.69
  7. Alaska · Alaska$467.65+$78.95

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

43226 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$368.66$107.97
ArkansasArkansas$362.76$106.84
ArizonaArizona$403.20$114.50
Bakersfield, CACalifornia$443.57$117.03
Chico, CACalifornia$442.54$116.01
El Centro, CACalifornia$442.60$116.07
Fresno, CACalifornia$442.54$116.01
Hanford, CACalifornia$442.54$116.01

43226 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.

$362.76

$503.08

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

View every state and territory as a table
43226 office rate range by state
State / territoryOffice rate rangeLocalities
AK$467.651
AL$368.661
AR$362.761
AZ$403.201
CA$442.54–$563.6129
CO$434.561
CT$444.591
DC$479.261
DE$410.361
FL$406.69–$447.103
GA$381.81–$423.092
GU$455.371
HI$455.371
IA$379.841
ID$382.411
IL$393.20–$433.884
IN$384.881
KS$377.501
KY$377.481
LA$376.68–$397.322
MA$431.41–$480.922
MD$418.88–$479.263
ME$384.20–$407.762
MI$387.99–$411.862
MN$416.291
MO$369.27–$399.343
MS$366.121
MT$415.151
NC$388.701
ND$408.031
NE$382.261
NH$427.211
NJ$449.64–$473.432
NM$390.171
NV$413.501
NY$395.09–$492.575
OH$386.531
OK$377.151
OR$410.28–$449.932
PA$387.42–$432.352
PR$418.631
RI$426.161
SC$388.261
SD$407.191
TN$379.551
TX$384.59–$433.118
UT$394.131
VA$406.02–$479.262
VI$418.631
VT$405.931
WA$430.75–$491.602
WI$392.981
WV$377.081
WY$412.051

See 43226 in every payment locality

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

Office or facility?

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.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,156

Code
43226
Physician work
2.18
Practice expense
9.89
Malpractice
0.36

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 43226 in North Carolina
ComponentRVULocality factorAdjusted
Physician work2.18× 1.0002.1800
Practice expense9.89× 0.9339.2274
Malpractice0.36× 0.6390.2300
Total RVUs11.6374
Conversion factor× 33.4009

Office rate, North Carolina$388.70

Office: (2.18 × 1 + 9.89 × 0.933 + 0.36 × 0.639) × $33.4009 = $388.70

Facility: (2.18 × 1 + 0.97 × 0.933 + 0.36 × 0.639) × $33.4009 = $110.73

Open 43226 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 43226

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

Codes related to 43226
CodeHow it relatesOffice range, North Carolina
Used instead
43220Esophageal dilation, balloon under 30 mmEsophageal balloon dilation for a diameter under 30 mm uses this method-specific code.$895.57
43214Esophageal dilation, balloon 30 mm or largerUse for esophageal balloon dilation at 30 mm or larger.No office rate
43213Esophageal dilation, retrograde balloon techniqueDescribes esophageal dilation performed by a retrograde approach.$1,173.69
43233Esophageal dilation, balloon 30 mm or largerUpper endoscopy with balloon dilation at 30 mm or larger, rather than guidewire dilation by esophagoscopy.No office rate

How 43226 has changed in North Carolina

43226 · Office / nonfacility

$388.70

Effective 2026-10-01

The base rate is $45.98 higher than on 2025-10-01, moving from $342.72 to $388.70 (13.4%).

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

    $342.72changed to$388.70

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.24 changed to 2.18
    • Practice expense RVU 8.75 changed to 9.89
    • Malpractice RVU 0.38 changed to 0.36
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $358.41changed to$342.72

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.95 changed to 8.75
    • Malpractice RVU 0.36 changed to 0.38

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $352.56changed to$358.41

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $369.31changed to$352.56

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.06 changed to 8.95
    • Malpractice RVU 0.35 changed to 0.36
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $385.22changed to$369.31

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.29 changed to 9.06
    • Malpractice RVU 0.33 changed to 0.35
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $378.37changed to$385.22

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 8.98 changed to 9.29

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $345.67changed to$378.37

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.63 changed to 8.98
    • Malpractice RVU 0.32 changed to 0.33
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $324.28changed to$345.67

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 6.99 changed to 7.63
    • Malpractice RVU 0.36 changed to 0.32
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $304.99changed to$324.28

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.44 changed to 6.99
    • Malpractice RVU 0.34 changed to 0.36

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $304.50changed to$304.99

    • Conversion factor 35.8887 changed to 35.9996
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $364.06changed to$304.50

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.34 changed to 2.24
    • Practice expense RVU 8.12 changed to 6.44
    • Malpractice RVU 0.36 changed to 0.34
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $368.32changed to$364.06

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.20 changed to 8.12
    • Malpractice RVU 0.37 changed to 0.36

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $366.49changed to$368.32

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $364.23changed to$366.49

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.15 changed to 8.20
    • Malpractice RVU 0.35 changed to 0.37
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$364.23

    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$388.70$110.73RVU26D
2026-07-01$388.70$110.73RVU26C
2026-04-01$388.70$110.73RVU26B
2026-01-01$388.70$110.73RVU26A
2025-10-01$342.72$119.27RVU25D
2025-07-01$342.72$119.27RVU25C
2025-04-01$342.72$119.27RVU25B
2025-01-01$342.72$119.27RVU25A
2024-10-01$358.41$121.68RVU24D
2024-07-01$358.41$121.68RVU24C
2024-04-01$358.41$121.68RVU24B
2024-03-09$358.41$121.68RVU24AR
2024-01-01$352.56$119.69RVU24A
2023-10-01$369.31$123.97RVU23D
2023-07-01$369.31$123.97RVU23C
2023-04-01$369.31$123.97RVU23B
2023-01-01$369.31$123.97RVU23A
2022-10-01$385.22$127.01RVU22D
2022-07-01$385.22$127.01RVU22C
2022-04-01$385.22$127.01RVU22B
2022-01-01$385.22$127.01RVU22A
2021-10-01$378.37$127.42RVU21D
2021-07-01$378.37$127.42RVU21C
2021-04-01$378.37$127.42RVU21B
2021-01-01$378.37$127.42RVU21A
2020-10-01$345.67$129.52RVU20D
2020-07-01$345.67$129.52RVU20C
2020-04-01$345.67$129.52RVU20B
2020-01-01$345.67$129.52RVU20A
2019-10-01$324.28$130.01RVU19D
2019-07-01$324.28$130.01RVU19C
2019-04-01$324.28$130.01RVU19B
2019-01-01$324.28$130.01RVU19A
2018-10-01$304.99$130.03RVU18D
2018-07-01$304.99$130.03RVU18C
2018-04-01$304.99$130.03RVU18B
2018-01-01$304.99$130.03RVU18AR1
2017-10-01$304.50$131.09RVU17D
2017-07-01$304.50$131.09RVU17C
2017-04-01$304.50$131.09RVU17B
2017-01-01$304.50$131.09RVU17A
2016-10-01$364.06$136.64RVU16D
2016-07-01$364.06$136.64RVU16C
2016-04-01$364.06$136.64RVU16B
2016-01-01$364.06$136.64RVU16A
2015-10-01$368.32$138.74RVU15D
2015-07-01$368.32$138.74RVU15C
2015-04-01$366.49$138.05RVU15B
2015-01-01$366.49$138.05RVU15A
2014-10-01$364.23$137.60RVU14D
2014-07-01$364.23$137.60RVU14C
2014-04-01$364.23$137.60RVU14B
2014-01-01$364.23$137.60RVU14A
2013-10-01Not available in this setting$135.67RVU13D
2013-07-01Not available in this setting$135.67RVU13C
2013-04-01Not available in this setting$135.67RVU13B
2013-01-01Not available in this setting$135.67RVU13AR

Price 43226 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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
RVUs for 43226PPRRVU2026_Oct_nonQPP.csv, line 5,156 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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