CPT code 43233: Esophageal dilation, balloon 30 mm or larger2026 Medicare rate & RVUs in Maryland
Reports upper endoscopy with balloon dilation of an esophageal narrowing using a balloon 30 mm or larger, including pneumatic dilation for achalasia.
CMS doesn’t publish an office rate for 43233 in Maryland.
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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What 43233 covers
A gastroenterologist or other qualified physician passes an upper endoscope through the mouth to examine the esophagus and perform balloon dilation with a balloon measuring 30 mm or larger. The service may be used for an esophageal narrowing or for pneumatic dilation in achalasia. It is commonly performed in a hospital endoscopy unit or ambulatory surgery center; office use is less common.
Choose this code based on the esophageal treatment and balloon diameter, not simply because an upper endoscopy was performed. The report should identify the esophageal indication and treatment site, document balloon size and dilation, and describe the findings and response. Medicare 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. 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 43233 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $214.82 |
| Rest of Maryland | Unavailable | $204.32 |
| Washington, DC area | Unavailable | $222.62 |
How the 43233 rate is calculated
Each of 43233’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 · 43233
RVUs × geographic indexes × conversion factor
Work3.97
3.97 RVUs× 1.000 GPCI
Practice expense1.52
1.52 RVUs× 1.000 GPCI
Malpractice0.62
0.62 RVUs× 1.000 GPCI
Adjusted RVUs
6.1100
Conversion factor
$33.4009
Medicare rate
$204.08
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43233
The CMS indicators that decide how 43233 is paid alongside other services.
CMS payment indicators · 43233
Esophageal dilation, balloon 30 mm or larger
| 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
43233 without 51 · national facility
$204.08
Esophageal dilation, balloon 30 mm or larger
43233-51 · Second procedure: 50%
$102.04
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%).
43233 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43249Esophageal dilationBalloon under 30 mm
- Both describe esophageal balloon dilation during upper endoscopy. The balloon size distinguishes them: 43233 is for 30 mm or larger, while 43249 is for less than 30 mm.
- 43248Esophageal dilationGuidewire-assisted
- 43233 describes large-balloon dilation. Choose 43248 when the esophagus is dilated over a guidewire instead.
- 43245EGD dilationGastric outlet obstruction
- 43233 treats an esophageal narrowing with a large balloon; 43245 describes dilation of the gastric outlet.
43233 billing questions
When should 43233 be chosen instead of 43249?
Use 43233 for esophageal balloon dilation with a balloon 30 mm or larger. Code 43249 describes esophageal balloon dilation with a balloon smaller than 30 mm.
How does 43233 differ from guidewire dilation?
43233 describes balloon dilation using a balloon at least 30 mm in diameter. Code 43248 is used for esophageal dilation over a guidewire rather than this large-balloon service.
Can the diagnostic upper endoscopy be reported separately?
Do not report a separate diagnostic EGD code just for inspection performed as part of the dilation. When related endoscopies are performed together, Medicare applies endoscopy family pricing.
Is modifier 50 appropriate for this code?
No. The anatomy and service descriptor make bilateral reporting with modifier 50 inappropriate.
What should the procedure note document?
Document the esophageal indication and treatment site, the balloon diameter used, the dilation performed, and relevant findings and response. The balloon must measure 30 mm or larger for this code.
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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