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CPT code 43245: EGD dilation, gastric outlet obstruction2026 Medicare rate & RVUs in Puerto Rico

Reports upper endoscopic dilation of an obstructed gastric outlet, such as a narrowed pylorus, to improve passage from the stomach.

CMS RVU26DEffective Oct 1, 2026One payment locality14.1K Medicare services in 2024

In Puerto Rico, Medicare pays $660.73 for 43245 in the office and $157.24 when it’s performed in a hospital or facility.

$660.73Office (non-facility)
$157.24Hospital or facility
+0.9%vs the national office rate ($654.99)

Check a contract rate as a % of Medicare · 43245 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 43245 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 43245 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 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.

How Puerto Rico compares for 43245

Across 109 of 109 payment localities, the office rate for 43245 runs from $571.94 in Arkansas to $898.52 in San Benito County, CA. Puerto Rico pays $660.73. The RVUs are the same everywhere; the geographic indexes change the dollars.

43245 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$660.73
  2. Los Angeles, CA · California$753.35+$92.62
  3. Washington, DC area · District of Columbia$758.24+$97.51
  4. Miami, FL · Florida$698.61+$37.88
  5. Chicago, IL · Illinois$676.56+$15.83
  6. Manhattan, NY · New York$757.23+$96.50
  7. Alaska · Alaska$733.94+$73.21

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

43245 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$581.31$145.55
ArkansasArkansas$571.94$144.15
ArizonaArizona$636.21$153.64
Bakersfield, CACalifornia$703.32$157.51
Chico, CACalifornia$702.10$156.28
El Centro, CACalifornia$702.17$156.35
Fresno, CACalifornia$702.10$156.28
Hanford, CACalifornia$702.10$156.28

43245 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.

$571.94

$800.31

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

View every state and territory as a table
43245 office rate range by state
State / territoryOffice rate rangeLocalities
AK$733.941
AL$581.311
AR$571.941
AZ$636.211
CA$702.10–$898.5229
CO$687.731
CT$701.581
DC$758.241
DE$647.591
FL$638.25–$698.613
GA$599.28–$666.762
GU$723.171
HI$723.171
IA$600.571
ID$604.341
IL$615.84–$681.124
IN$608.311
KS$596.121
KY$593.771
LA$592.21–$624.992
MA$682.41–$762.462
MD$661.33–$758.243
ME$606.43–$644.952
MI$609.76–$645.692
MN$660.801
MO$580.00–$629.063
MS$576.161
MT$654.961
NC$613.701
ND$646.661
NE$604.631
NH$675.411
NJ$710.11–$748.782
NM$612.931
NV$653.191
NY$623.79–$775.635
OH$608.061
OK$594.001
OR$648.66–$713.032
PA$609.88–$681.672
PR$660.731
RI$673.231
SC$611.791
SD$645.681
TN$599.291
TX$605.33–$684.968
UT$621.121
VA$641.67–$758.242
VI$660.731
VT$642.651
WA$681.60–$780.192
WI$622.571
WV$590.201
WY$651.341

See 43245 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,173

Code
43245
Physician work
3.00
Practice expense
16.19
Malpractice
0.42

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 43245 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work3.00× 1.0003.0000
Practice expense16.19× 1.01116.3681
Malpractice0.42× 0.9850.4137
Total RVUs19.7818
Conversion factor× 33.4009

Office rate, Puerto Rico$660.73

Office: (3 × 1 + 16.19 × 1.011 + 0.42 × 0.985) × $33.4009 = $660.73

Facility: (3 × 1 + 1.28 × 1.011 + 0.42 × 0.985) × $33.4009 = $157.24

Open 43245 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 43245

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

Codes related to 43245
CodeHow it relatesOffice range, Puerto Rico
Used instead
43249Esophageal dilation, balloon under 30 mmFor balloon dilation of an esophageal narrowing rather than a gastric outlet obstruction.$1,192.16
43233Esophageal dilation, balloon 30 mm or largerFor large-balloon dilation of an esophageal narrowing, not gastric outlet dilation.No office rate
43248Esophageal dilation, guidewire-assistedAddresses esophageal dilation using a guidewire technique, not dilation of the gastric outlet.$461.62

How 43245 has changed in Puerto Rico

43245 · Office / nonfacility

$660.73

Effective 2026-10-01

The base rate is $100.25 higher than on 2025-10-01, moving from $560.48 to $660.73 (17.9%).

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

    $560.48changed to$660.73

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.08 changed to 3.00
    • Practice expense RVU 13.69 changed to 16.19
    • Malpractice RVU 0.47 changed to 0.42
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $592.90changed to$560.48

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 14.20 changed to 13.69
    • Malpractice RVU 0.44 changed to 0.47

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $583.22changed to$592.90

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $611.62changed to$583.22

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 14.43 changed to 14.20
    • Malpractice RVU 0.43 changed to 0.44
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $607.94changed to$611.62

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $644.17changed to$607.94

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 15.01 changed to 14.43
    • Malpractice RVU 0.41 changed to 0.43
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $650.91changed to$644.17

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 15.04 changed to 15.01
    • Malpractice RVU 0.42 changed to 0.41

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $609.61changed to$650.91

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 13.30 changed to 15.04
    • Malpractice RVU 0.41 changed to 0.42
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $587.59changed to$609.61

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 12.69 changed to 13.30
    • Malpractice RVU 0.45 changed to 0.41
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $570.99changed to$587.59

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 12.23 changed to 12.69
    • Malpractice RVU 0.47 changed to 0.45

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $493.78changed to$570.99

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 12.13 changed to 12.23
    • Malpractice RVU 0.46 changed to 0.47
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $466.22changed to$493.78

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.18 changed to 3.08
    • Practice expense RVU 13.76 changed to 12.13
    • Malpractice RVU 0.48 changed to 0.46
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $474.30changed to$466.22

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 14.00 changed to 13.76
    • Malpractice RVU 0.51 changed to 0.48

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $471.94changed to$474.30

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $461.41changed to$471.94

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 13.83 changed to 14.00
    • Malpractice RVU 0.48 changed to 0.51
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    No ratechanged to$461.41

    Held through RVU14B, RVU14C, RVU14D.

  17. 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$660.73$157.24RVU26D
2026-07-01$660.73$157.24RVU26C
2026-04-01$660.73$157.24RVU26B
2026-01-01$660.73$157.24RVU26A
2025-10-01$560.48$169.60RVU25D
2025-07-01$560.48$169.60RVU25C
2025-04-01$560.48$169.60RVU25B
2025-01-01$560.48$169.60RVU25A
2024-10-01$592.90$172.89RVU24D
2024-07-01$592.90$172.89RVU24C
2024-04-01$592.90$172.89RVU24B
2024-03-09$592.90$172.89RVU24AR
2024-01-01$583.22$170.07RVU24A
2023-10-01$611.62$175.07RVU23D
2023-07-01$607.94$174.86RVU23C
2023-04-01$607.94$174.86RVU23B
2023-01-01$607.94$174.86RVU23A
2022-10-01$644.17$178.13RVU22D
2022-07-01$644.17$178.13RVU22C
2022-04-01$644.17$178.13RVU22B
2022-01-01$644.17$178.13RVU22A
2021-10-01$650.91$179.60RVU21D
2021-07-01$650.91$179.60RVU21C
2021-04-01$650.91$179.60RVU21B
2021-01-01$650.91$179.60RVU21A
2020-10-01$609.61$183.62RVU20D
2020-07-01$609.61$183.62RVU20C
2020-04-01$609.61$183.62RVU20B
2020-01-01$609.61$183.62RVU20A
2019-10-01$587.59$185.12RVU19D
2019-07-01$587.59$185.12RVU19C
2019-04-01$587.59$185.12RVU19B
2019-01-01$587.59$185.12RVU19A
2018-10-01$570.99$186.36RVU18D
2018-07-01$570.99$186.36RVU18C
2018-04-01$570.99$186.36RVU18B
2018-01-01$570.99$186.36RVU18AR1
2017-10-01$493.78$170.90RVU17D
2017-07-01$493.78$170.90RVU17C
2017-04-01$493.78$170.90RVU17B
2017-01-01$493.78$170.90RVU17A
2016-10-01$466.22$160.79RVU16D
2016-07-01$466.22$160.79RVU16C
2016-04-01$466.22$160.79RVU16B
2016-01-01$466.22$160.79RVU16A
2015-10-01$474.30$162.70RVU15D
2015-07-01$474.30$162.70RVU15C
2015-04-01$471.94$161.89RVU15B
2015-01-01$471.94$161.89RVU15A
2014-10-01$461.41$161.21RVU14D
2014-07-01$461.41$161.21RVU14C
2014-04-01$461.41$161.21RVU14B
2014-01-01$461.41$161.21RVU14A
2013-10-01Not available in this setting$156.95RVU13D
2013-07-01Not available in this setting$156.95RVU13C
2013-04-01Not available in this setting$156.95RVU13B
2013-01-01Not available in this setting$156.95RVU13AR

Price 43245 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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

Show the CMS file lines behind this rate
RVUs for 43245PPRRVU2026_Oct_nonQPP.csv, line 5,173 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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