CPT code 43245: EGD dilation, gastric outlet obstruction2026 Medicare rate & RVUs in Missouri
Reports upper endoscopic dilation of an obstructed gastric outlet, such as a narrowed pylorus, to improve passage from the stomach.
Medicare pays $580.00–$629.06 for 43245 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 43245 covers
A gastroenterologist or other qualified endoscopist advances an upper endoscope to the stomach and dilates a narrowed gastric outlet to relieve obstruction. The target is the pyloric channel or another gastric outlet narrowing, not an esophageal stricture. Dilation may use a balloon or a guidewire-based technique. The service is performed in settings such as a hospital outpatient department or ambulatory surgery center, with the choice based on the patient and clinical circumstances.
Select this code when the treated narrowing is at the gastric outlet; esophageal dilation codes describe a different site. The report should identify the narrowing and its location, the indication for dilation, the method used, and the result. 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 service. Medicare does not pay an assistant at surgery, and 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 43245 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$580.00 to $629.06
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $621.68 | $154.05 |
| Metropolitan St. Louis, MO | $629.06 | $154.96 |
| Rest of Missouri | $580.00 | $150.72 |
How the 43245 rate is calculated
Each of 43245’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 · 43245
RVUs × geographic indexes × conversion factor
Work3.00
3.00 RVUs× 1.000 GPCI
Practice expense16.19
16.19 RVUs× 1.000 GPCI
Malpractice0.42
0.42 RVUs× 1.000 GPCI
Adjusted RVUs
19.6100
Conversion factor
$33.4009
Medicare rate
$654.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43245
The CMS indicators that decide how 43245 is paid alongside other services.
CMS payment indicators · 43245
EGD dilation, gastric outlet obstruction
| 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
43245 without 51 · national office
$654.99
EGD dilation, gastric outlet obstruction
43245-51 · Second procedure: 50%
$327.50
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%).
43245 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43249Esophageal dilationBalloon under 30 mm
- 43245 treats an obstructed gastric outlet. 43249 is for balloon dilation of an esophageal narrowing using a balloon smaller than 30 mm.
- 43233Esophageal dilationBalloon 30 mm or larger
- 43233 is for balloon dilation of an esophageal narrowing with a balloon 30 mm or larger; 43245 targets a gastric outlet obstruction.
- 43248Esophageal dilationGuidewire-assisted
- 43248 concerns esophageal dilation using a guidewire. Use 43245 when the treated obstruction is at the gastric outlet.
43245 billing questions
When should this code be chosen instead of 43249?
Use 43245 for dilation of a gastric outlet obstruction, such as a pyloric narrowing. Code 43249 describes balloon dilation of an esophageal narrowing.
Does this code include the diagnostic upper endoscopy?
The endoscopic examination used to locate and treat the gastric outlet narrowing is part of the dilation service. Do not report a separate diagnostic EGD for that same examination.
What documentation supports reporting this service?
Document the obstructing narrowing and its location, the clinical reason for dilation, the dilation technique, and the findings or outcome.
How does CMS price this with another endoscopy in the same session?
When related endoscopies are performed together, CMS applies endoscopy family pricing. The applicable payment reflects that pricing rule.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
Is modifier 50 appropriate for dilation on both sides?
No. Modifier 50 is inappropriate for this service because the descriptor or anatomy does not support bilateral reporting.
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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