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CPT code 43248: Esophageal dilation, guidewire-assisted2026 Medicare rate & RVUs in Queens, NY

Report guidewire-assisted esophageal dilation during upper endoscopy when a dilator is advanced over a wire to treat an esophageal narrowing.

CMS RVU26DEffective Oct 1, 2026One payment locality122.8K Medicare services in 2024

In Queens, NY, Medicare pays $533.03 for 43248 in the office and $166.66 when it’s performed in a hospital or facility.

$533.03Office (non-facility)
$166.66Hospital or facility
+16.4%vs the national office rate ($457.93)

Check a contract rate as a % of Medicare · 43248 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 43248 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 43248 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 43248 covers

During upper endoscopy, the physician passes a guide wire through the narrowed esophagus and advances a dilator over it to widen the passage. Gastroenterologists and other physicians trained in endoscopy commonly perform this for symptomatic esophageal strictures, such as narrowing that causes difficulty swallowing, in hospital outpatient departments and ambulatory surgery centers.

Choose this code when the documented dilation is performed over a guide wire; record the esophageal site, the narrowing treated, and the wire-guided technique. A balloon dilation of the esophagus is represented by a different code. This service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate. CMS does not pay for an assistant at surgery, and co-surgeons and team surgery are not permitted for this service.

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 Queens, NY compares for 43248

Across 109 of 109 payment localities, the office rate for 43248 runs from $402.83 in Arkansas to $618.55 in San Benito County, CA. Queens, NY pays $533.03. The RVUs are the same everywhere; the geographic indexes change the dollars.

43248 in Queens, NY vs other payment areas
  1. Queens, NY · this page$533.03
  2. Manhattan, NY · New York$527.63−$5.40
  3. NYC suburbs and Long Island, NY · New York$540.20+$7.17
  4. Poughkeepsie and northern NYC suburbs, NY · New York$497.99−$35.04
  5. Rest of New York · New York$436.97−$96.06
  6. Los Angeles, CA · California$522.36−$10.67
  7. Washington, DC area · District of Columbia$526.94−$6.09

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

43248 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$489.71$167.04
Chicago, ILIllinois$475.06$163.55
AlaskaAlaska$523.12$193.01
AlabamaAlabama$409.03$137.82
ArkansasArkansas$402.83$136.57
ArizonaArizona$445.39$145.04
Bakersfield, CACalifornia$489.05$149.34
Chico, CACalifornia$488.03$148.32

43248 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.

$402.83

$553.29

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

View every state and territory as a table
43248 office rate range by state
State / territoryOffice rate rangeLocalities
AK$523.121
AL$409.031
AR$402.831
AZ$445.391
CA$488.03–$618.5529
CO$479.091
CT$489.291
DC$526.941
DE$453.031
FL$448.16–$489.713
GA$422.12–$466.122
GU$501.331
HI$501.331
IA$421.181
ID$423.801
IL$433.72–$476.854
IN$426.411
KS$418.531
KY$417.921
LA$417.00–$438.722
MA$475.78–$528.802
MD$462.16–$526.943
ME$425.50–$450.572
MI$428.79–$453.412
MN$460.131
MO$409.09–$441.073
MS$406.071
MT$457.901
NC$430.261
ND$451.181
NE$423.781
NH$470.931
NJ$495.18–$520.952
NM$431.021
NV$456.381
NY$436.97–$540.205
OH$427.421
OK$417.761
OR$453.15–$495.582
PA$428.46–$476.252
PR$461.621
RI$470.111
SC$429.491
SD$450.391
TN$420.661
TX$425.47–$477.228
UT$435.671
VA$448.61–$526.942
VI$461.621
VT$448.801
WA$475.09–$540.432
WI$435.301
WV$416.751
WY$454.971

See 43248 in every payment locality

How the 43248 rate is calculated

Each of 43248’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 · 43248

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.84

2.84 RVUs× 1.000 GPCI

Practice expense10.53

10.53 RVUs× 1.000 GPCI

Malpractice0.34

0.34 RVUs× 1.000 GPCI

Adjusted RVUs

13.7100

Conversion factor

$33.4009

Medicare rate

$457.93

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,176

Code
43248
Physician work
2.84
Practice expense
10.53
Malpractice
0.34

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 43248 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work2.84× 1.0643.0218
Practice expense10.53× 1.18212.4465
Malpractice0.34× 1.4420.4903
Total RVUs15.9585
Conversion factor× 33.4009

Office rate, Queens, NY$533.03

Office: (2.84 × 1.064 + 10.53 × 1.182 + 0.34 × 1.442) × $33.4009 = $533.03

Facility: (2.84 × 1.064 + 1.25 × 1.182 + 0.34 × 1.442) × $33.4009 = $166.66

Open 43248 in the RVU calculator

Payment rules and modifiers for 43248

The CMS indicators that decide how 43248 is paid alongside other services.

CMS payment indicators · 43248

Esophageal dilation, guidewire-assisted

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

43248 without 51 · national office

$457.93

Esophageal dilation, guidewire-assisted

43248-51 · Second procedure: 50%

$228.97

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 43248

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

Codes related to 43248
CodeHow it relatesOffice range, Queens, NY
Used instead
43249Esophageal dilation, balloon under 30 mmEsophageal dilation by balloon rather than over a guide wire.$1,387.58

How 43248 has changed in Queens, NY

43248 · Office / nonfacility

$533.03

Effective 2026-10-01

The base rate is $72.51 higher than on 2025-10-01, moving from $460.52 to $533.03 (15.7%).

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

    $460.52changed to$533.03

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.91 changed to 2.84
    • Practice expense RVU 8.88 changed to 10.53
    • Malpractice RVU 0.36 changed to 0.34
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $483.07changed to$460.52

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 9.11 changed to 8.88

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $475.18changed to$483.07

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $505.70changed to$475.18

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.17 changed to 9.11
    • Malpractice RVU 0.35 changed to 0.36
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $539.17changed to$505.70

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.47 changed to 9.17
    • Malpractice RVU 0.33 changed to 0.35
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $530.29changed to$539.17

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 9.18 changed to 9.47
    • Malpractice RVU 0.32 changed to 0.33

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $481.80changed to$530.29

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.84 changed to 9.18
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $452.05changed to$481.80

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.23 changed to 7.84
    • Malpractice RVU 0.38 changed to 0.32
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $427.89changed to$452.05

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.70 changed to 7.23
    • Malpractice RVU 0.37 changed to 0.38

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $426.02changed to$427.89

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.66 changed to 6.70
    • Malpractice RVU 0.38 changed to 0.37
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $495.85changed to$426.02

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.01 changed to 2.91
    • Practice expense RVU 8.20 changed to 6.66
    • Malpractice RVU 0.39 changed to 0.38
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $509.31changed to$495.85

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.38 changed to 8.20
    • Malpractice RVU 0.44 changed to 0.39

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $506.78changed to$509.31

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $496.41changed to$506.78

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.29 changed to 8.38
    • Malpractice RVU 0.41 changed to 0.44
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$496.41

    Held through RVU14B, RVU14C, RVU14D.

  16. 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$533.03$166.66RVU26D
2026-07-01$533.03$166.66RVU26C
2026-04-01$533.03$166.66RVU26B
2026-01-01$533.03$166.66RVU26A
2025-10-01$460.52$181.05RVU25D
2025-07-01$460.52$181.05RVU25C
2025-04-01$460.52$181.05RVU25B
2025-01-01$460.52$181.05RVU25A
2024-10-01$483.07$185.92RVU24D
2024-07-01$483.07$185.92RVU24C
2024-04-01$483.07$185.92RVU24B
2024-03-09$483.07$185.92RVU24AR
2024-01-01$475.18$182.89RVU24A
2023-10-01$505.70$195.20RVU23D
2023-07-01$505.70$195.20RVU23C
2023-04-01$505.70$195.20RVU23B
2023-01-01$505.70$195.20RVU23A
2022-10-01$539.17$205.15RVU22D
2022-07-01$539.17$205.15RVU22C
2022-04-01$539.17$205.15RVU22B
2022-01-01$539.17$205.15RVU22A
2021-10-01$530.29$205.50RVU21D
2021-07-01$530.29$205.50RVU21C
2021-04-01$530.29$205.50RVU21B
2021-01-01$530.29$205.50RVU21A
2020-10-01$481.80$206.21RVU20D
2020-07-01$481.80$206.21RVU20C
2020-04-01$481.80$206.21RVU20B
2020-01-01$481.80$206.21RVU20A
2019-10-01$452.05$207.27RVU19D
2019-07-01$452.05$207.27RVU19C
2019-04-01$452.05$207.27RVU19B
2019-01-01$452.05$207.27RVU19A
2018-10-01$427.89$207.58RVU18D
2018-07-01$427.89$207.58RVU18C
2018-04-01$427.89$207.58RVU18B
2018-01-01$427.89$207.58RVU18AR1
2017-10-01$426.02$207.68RVU17D
2017-07-01$426.02$207.68RVU17C
2017-04-01$426.02$207.68RVU17B
2017-01-01$426.02$207.68RVU17A
2016-10-01$495.85$214.23RVU16D
2016-07-01$495.85$214.23RVU16C
2016-04-01$495.85$214.23RVU16B
2016-01-01$495.85$214.23RVU16A
2015-10-01$509.31$221.08RVU15D
2015-07-01$509.31$221.08RVU15C
2015-04-01$506.78$219.98RVU15B
2015-01-01$506.78$219.98RVU15A
2014-10-01$496.41$214.26RVU14D
2014-07-01$496.41$214.26RVU14C
2014-04-01$496.41$214.26RVU14B
2014-01-01$496.41$214.26RVU14A
2013-10-01Not available in this setting$218.37RVU13D
2013-07-01Not available in this setting$218.37RVU13C
2013-04-01Not available in this setting$218.37RVU13B
2013-01-01Not available in this setting$218.37RVU13AR

Price 43248 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

43248 billing questions

How does this differ from code 43249?

Code 43248 represents dilation over a guide wire. Code 43249 is used for esophageal balloon dilation with a balloon smaller than 30 mm.

Can the diagnostic EGD be reported separately?

The endoscopic inspection is part of the therapeutic procedure when performed to guide the dilation. Do not separately report a diagnostic EGD for that same work.

What documentation supports code 43248?

Document the esophageal narrowing treated and that dilation was performed over a guide wire. The record should support that the service was not balloon dilation.

Should modifier 50 be appended?

No. Bilateral adjustment is inappropriate for this service, so modifier 50 should not be used.

How are related endoscopies handled when performed in the same session?

CMS endoscopy-family pricing applies when related endoscopies are performed together. The procedure has a 0-day global period, with same-day preoperative and postoperative care included.

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 43248PPRRVU2026_Oct_nonQPP.csv, line 5,176 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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