CPT code 43229: Esophageal ablation, flexible transoral scope2026 Medicare rate & RVUs in Illinois
Reports flexible transoral esophagoscopy with energy-based treatment of an esophageal lesion, such as dysplastic Barrett’s tissue, rather than lesion excision.
Medicare pays $732.67–$810.96 for 43229 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 43229 covers
A gastroenterologist or other qualified endoscopist advances a flexible scope through the mouth to visualize and ablate targeted esophageal tissue. A typical setting is endoscopic treatment of Barrett’s esophagus with dysplasia; the treatment destroys the target tissue rather than removing it with forceps or a snare. The service is distinct from diagnostic inspection, biopsy, and endoscopic removal of a lesion.
Report the code when the documented service includes esophageal lesion ablation, not merely examination or tissue sampling. The procedure note should identify the treated esophageal site and lesion, the ablation performed, and the clinical indication. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate for this descriptor and anatomy. Medicare does not pay an assistant at surgery for this service; 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.
Where 43229 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$732.67 to $810.96
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $803.72 | $193.45 |
| East St. Louis, IL | $743.43 | $184.78 |
| Rest of Illinois | $732.67 | $178.27 |
| Suburban Chicago, IL | $810.96 | $187.33 |
How the 43229 rate is calculated
Each of 43229’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 · 43229
RVUs × geographic indexes × conversion factor
Work3.40
3.40 RVUs× 1.000 GPCI
Practice expense19.60
19.60 RVUs× 1.000 GPCI
Malpractice0.41
0.41 RVUs× 1.000 GPCI
Adjusted RVUs
23.4100
Conversion factor
$33.4009
Medicare rate
$781.92
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43229
The CMS indicators that decide how 43229 is paid alongside other services.
CMS payment indicators · 43229
Esophageal ablation, flexible transoral scope
| 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
43229 without 51 · national office
$781.92
Esophageal ablation, flexible transoral scope
43229-51 · Second procedure: 50%
$390.96
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%).
43229 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43216Esophageal lesion removalHot forceps or bipolar cautery
- Choose 43216 when the esophageal lesion is removed with forceps or cautery. This code represents ablation rather than lesion extraction.
- 43217Esophageal lesion removalSnare technique
- Choose 43217 for esophageal lesion removal by snare. Use this code when the treatment destroys the target tissue by ablation instead.
- 43235Upper GI endoscopyDiagnostic, brushings or washings
- 43235 is for diagnostic upper endoscopy without the lesion-ablation service. It does not describe therapeutic destruction of esophageal tissue.
43229 billing questions
How is ablation distinguished from endoscopic lesion removal?
Use this code for ablation of the esophageal target. Codes 43216 and 43217 describe lesion removal by specific techniques, including forceps or cautery and snare removal.
Can this code be reported for diagnostic esophagoscopy alone?
No. The service must include treatment by ablation; inspection or biopsy without ablation does not support this code.
Is modifier 50 appropriate for ablation on both sides of the esophagus?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor and anatomy.
How are related endoscopies priced when performed together?
CMS applies endoscopy-family pricing when related endoscopies are performed together, rather than pricing each related scope service independently.
Does Medicare pay an assistant or co-surgeon for this procedure?
An assistant at surgery is not paid 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
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