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

In Tennessee, Medicare pays $379.55 for 43226 in the office and $108.72 when it’s performed in a hospital or facility.

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.

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 Tennessee 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. Tennessee pays $379.55. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43226 rates by state

Office rate range in each state. Select a state to see its payment localities.

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.

Payment rules and modifiers for 43226

The CMS indicators that decide how 43226 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 43226

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

How 43226 has changed in Tennessee

Price 43226 for an earlier date of service

Where the Tennessee rate applies

Tennessee is a Medicare payment area, not a city. Our Census mapping connects it to 504 cities and communities in Tennessee. Some span more than one payment area; confirm with the service ZIP.

• Adams
• Adamsville
• Alamo
• Alcoa
• Alexandria
• Algood
• Allardt
• Altamont

Browse all communities in Tennessee

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

Open CMS sourceHow we calculate rates