CPT code 43249: Esophageal dilation, balloon under 30 mm2026 Medicare rate & RVUs in San Diego, CA
Reports upper endoscopy with balloon dilation of an esophageal narrowing using a balloon diameter under 30 mm, commonly to relieve dysphagia.
In San Diego, CA, Medicare pays $1,390.77 for 43249 in the office and $142.02 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 43249 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 43249 covers
A gastroenterologist or other endoscopist advances an upper endoscope through the mouth to the esophagus and expands a balloon across a narrowed area. Common indications include dysphagia from a benign esophageal stricture or ring. The code is for dilation of the esophagus with a balloon under 30 mm; it is not the code for dilation of a gastric outlet. The service is commonly performed in an ambulatory endoscopy center or hospital outpatient department.
Select the code based on the site and dilation technique, and document the esophageal narrowing, balloon method, and maximum balloon diameter. Report the endoscopic procedure once for the session, not once per inflation. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. Endoscopy-family pricing applies when related endoscopies are performed together. Modifier 50 is inappropriate; assistant-at-surgery services are statutorily nonpayable, and co-surgeon and team-surgery billing 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 San Diego, CA compares for 43249
Across 109 of 109 payment localities, the office rate for 43249 runs from $1,022.75 in Arkansas to $1,664.21 in San Benito County, CA. San Diego, CA pays $1,390.77. The RVUs are the same everywhere; the geographic indexes change the dollars.
- San Diego, CA · this page$1,390.77
- Bakersfield, CA · California$1,282.14−$108.63
- Chico, CA · California$1,281.23−$109.54
- El Centro, CA · California$1,281.28−$109.49
- Fresno, CA · California$1,281.23−$109.54
- Hanford, CA · California$1,281.23−$109.54
- Los Angeles, CA · California$1,378.87−$11.90
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $1,281.23 | $136.89 |
| Merced, CACalifornia | $1,281.23 | $136.89 |
| Modesto, CACalifornia | $1,281.23 | $136.89 |
| Napa, CACalifornia | $1,525.49 | $149.35 |
| Oxnard, CACalifornia | $1,376.24 | $142.10 |
| Redding, CACalifornia | $1,281.23 | $136.89 |
| Rest of CaliforniaCalifornia | $1,281.23 | $136.89 |
| Riverside, CACalifornia | $1,284.50 | $140.15 |
| Sacramento, CACalifornia | $1,355.48 | $141.18 |
| Salinas, CACalifornia | $1,350.71 | $140.59 |
| Marin County, CACalifornia | $1,627.46 | $155.26 |
| San Francisco, CACalifornia | $1,627.12 | $154.92 |
| San Benito County, CACalifornia | $1,664.21 | $158.60 |
| Santa Clara County, CACalifornia | $1,662.82 | $157.21 |
| San Luis Obispo, CACalifornia | $1,327.82 | $138.58 |
| Santa Cruz, CACalifornia | $1,410.52 | $141.92 |
| Santa Maria, CACalifornia | $1,358.04 | $140.60 |
| Santa Rosa, CACalifornia | $1,425.39 | $143.22 |
| Stockton, CACalifornia | $1,281.23 | $136.89 |
| Vallejo, CACalifornia | $1,525.00 | $148.86 |
| Visalia, CACalifornia | $1,281.23 | $136.89 |
| Yuba City, CACalifornia | $1,281.23 | $136.89 |
| Washington, DC areaDistrict of Columbia | $1,379.08 | $149.11 |
| Miami, FLFlorida | $1,240.13 | $153.21 |
| Chicago, ILIllinois | $1,199.39 | $150.06 |
| Manhattan, NYNew York | $1,367.35 | $154.09 |
| AlaskaAlaska | $1,289.74 | $177.76 |
| AlabamaAlabama | $1,040.60 | $127.00 |
| ArkansasArkansas | $1,022.75 | $125.86 |
| ArizonaArizona | $1,145.36 | $133.61 |
| ColoradoColorado | $1,248.58 | $137.65 |
| ConnecticutConnecticut | $1,267.66 | $143.15 |
| DelawareDelaware | $1,166.81 | $135.22 |
| Fort Lauderdale, FLFlorida | $1,202.57 | $144.88 |
| Rest of FloridaFlorida | $1,137.75 | $139.58 |
| Atlanta, GAGeorgia | $1,200.00 | $139.18 |
| Rest of GeorgiaGeorgia | $1,065.29 | $133.94 |
| Hawaii, Guam, HIHawaii | $1,324.61 | $137.46 |
| IowaIowa | $1,082.25 | $126.88 |
| IdahoIdaho | $1,088.43 | $127.84 |
| East St. Louis, ILIllinois | $1,103.87 | $143.28 |
| Rest of IllinoisIllinois | $1,091.76 | $138.49 |
| Suburban Chicago, ILIllinois | $1,217.99 | $145.68 |
| IndianaIndiana | $1,096.14 | $128.25 |
| KansasKansas | $1,071.40 | $127.52 |
| KentuckyKentucky | $1,059.26 | $131.05 |
| New Orleans, LALouisiana | $1,117.82 | $135.31 |
| Rest of LouisianaLouisiana | $1,055.36 | $131.32 |
| Metropolitan Boston, MAMassachusetts | $1,393.05 | $146.38 |
| Rest of MassachusettsMassachusetts | $1,237.17 | $137.72 |
| Baltimore area, MDMaryland | $1,263.25 | $142.92 |
| Rest of MarylandMaryland | $1,193.44 | $136.80 |
| Rest of MaineMaine | $1,089.92 | $129.33 |
| Southern Maine, MEMaine | $1,166.94 | $132.22 |
| Detroit, MIMichigan | $1,149.34 | $141.77 |
| Rest of MichiganMichigan | $1,087.41 | $134.14 |
| MinnesotaMinnesota | $1,204.76 | $130.36 |
| Metropolitan Kansas City, MOMissouri | $1,114.06 | $133.64 |
| Metropolitan St. Louis, MOMissouri | $1,128.40 | $134.40 |
| Rest of MissouriMissouri | $1,030.60 | $130.58 |
| MississippiMississippi | $1,027.16 | $128.18 |
| MontanaMontana | $1,180.37 | $136.26 |
| North CarolinaNorth Carolina | $1,104.17 | $130.02 |
| North DakotaNorth Dakota | $1,174.44 | $130.32 |
| NebraskaNebraska | $1,090.72 | $127.01 |
| New HampshireNew Hampshire | $1,223.56 | $136.64 |
| Northern New JerseyNew Jersey | $1,359.90 | $148.73 |
| Rest of New JerseyNew Jersey | $1,284.52 | $144.35 |
| New MexicoNew Mexico | $1,092.47 | $135.02 |
| NevadaNevada | $1,179.80 | $134.64 |
| NYC suburbs and Long Island, NYNew York | $1,399.32 | $157.87 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $1,289.33 | $146.03 |
| Queens, NYNew York | $1,387.58 | $153.44 |
| Rest of New YorkNew York | $1,123.24 | $131.33 |
| OhioOhio | $1,086.20 | $132.93 |
| OklahomaOklahoma | $1,062.22 | $129.82 |
| Portland, OROregon | $1,299.48 | $139.47 |
| Rest of OregonOregon | $1,173.08 | $133.14 |
| Metropolitan Philadelphia, PAPennsylvania | $1,228.31 | $141.39 |
| Rest of PennsylvaniaPennsylvania | $1,090.99 | $132.49 |
| Puerto RicoPuerto Rico | $1,192.16 | $136.56 |
| Rhode IslandRhode Island | $1,216.71 | $138.14 |
| South CarolinaSouth Carolina | $1,096.54 | $131.78 |
| South DakotaSouth Dakota | $1,173.73 | $129.62 |
| TennesseeTennessee | $1,077.15 | $128.05 |
| Austin, TXTexas | $1,242.26 | $137.59 |
| Beaumont, TXTexas | $1,082.16 | $132.02 |
| Brazoria, TXTexas | $1,169.13 | $134.41 |
| Dallas, TXTexas | $1,175.41 | $135.48 |
| Fort Worth, TXTexas | $1,164.71 | $135.21 |
| Galveston, TXTexas | $1,171.77 | $134.97 |
| Houston, TXTexas | $1,177.27 | $140.46 |
| Rest of TexasTexas | $1,124.16 | $133.29 |
| UtahUtah | $1,114.35 | $132.89 |
| VirginiaVirginia | $1,159.02 | $132.66 |
| Virgin Islands, VIUnited States Virgin Islands | $1,192.16 | $136.56 |
| VermontVermont | $1,164.60 | $130.93 |
| Rest of WashingtonWashington | $1,236.55 | $137.10 |
| King County, WAWashington | $1,428.86 | $147.73 |
| WisconsinWisconsin | $1,127.95 | $127.69 |
| West VirginiaWest Virginia | $1,042.76 | $135.43 |
| WyomingWyoming | $1,177.78 | $133.67 |
43249 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$1,022.75
$1,472.72
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,289.74 | 1 |
| AL | $1,040.60 | 1 |
| AR | $1,022.75 | 1 |
| AZ | $1,145.36 | 1 |
| CA | $1,281.23–$1,664.21 | 29 |
| CO | $1,248.58 | 1 |
| CT | $1,267.66 | 1 |
| DC | $1,379.08 | 1 |
| DE | $1,166.81 | 1 |
| FL | $1,137.75–$1,240.13 | 3 |
| GA | $1,065.29–$1,200.00 | 2 |
| GU | $1,324.61 | 1 |
| HI | $1,324.61 | 1 |
| IA | $1,082.25 | 1 |
| ID | $1,088.43 | 1 |
| IL | $1,091.76–$1,217.99 | 4 |
| IN | $1,096.14 | 1 |
| KS | $1,071.40 | 1 |
| KY | $1,059.26 | 1 |
| LA | $1,055.36–$1,117.82 | 2 |
| MA | $1,237.17–$1,393.05 | 2 |
| MD | $1,193.44–$1,379.08 | 3 |
| ME | $1,089.92–$1,166.94 | 2 |
| MI | $1,087.41–$1,149.34 | 2 |
| MN | $1,204.76 | 1 |
| MO | $1,030.60–$1,128.40 | 3 |
| MS | $1,027.16 | 1 |
| MT | $1,180.37 | 1 |
| NC | $1,104.17 | 1 |
| ND | $1,174.44 | 1 |
| NE | $1,090.72 | 1 |
| NH | $1,223.56 | 1 |
| NJ | $1,284.52–$1,359.90 | 2 |
| NM | $1,092.47 | 1 |
| NV | $1,179.80 | 1 |
| NY | $1,123.24–$1,399.32 | 5 |
| OH | $1,086.20 | 1 |
| OK | $1,062.22 | 1 |
| OR | $1,173.08–$1,299.48 | 2 |
| PA | $1,090.99–$1,228.31 | 2 |
| PR | $1,192.16 | 1 |
| RI | $1,216.71 | 1 |
| SC | $1,096.54 | 1 |
| SD | $1,173.73 | 1 |
| TN | $1,077.15 | 1 |
| TX | $1,082.16–$1,242.26 | 8 |
| UT | $1,114.35 | 1 |
| VA | $1,159.02–$1,379.08 | 2 |
| VI | $1,192.16 | 1 |
| VT | $1,164.60 | 1 |
| WA | $1,236.55–$1,428.86 | 2 |
| WI | $1,127.95 | 1 |
| WV | $1,042.76 | 1 |
| WY | $1,177.78 | 1 |
How the 43249 rate is calculated
Each of 43249’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 · 43249
RVUs × geographic indexes × conversion factor
Work2.60
2.60 RVUs× 1.000 GPCI
Practice expense32.44
32.44 RVUs× 1.000 GPCI
Malpractice0.30
0.30 RVUs× 1.000 GPCI
Adjusted RVUs
35.3400
Conversion factor
$33.4009
Medicare rate
$1,180.39
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact San Diego, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,177
- Code
- 43249
- Physician work
- 2.60
- Practice expense
- 32.44
- Malpractice
- 0.30
GPCI2026.csv
23
- Locality
- San Diego, CA
- Physician work
- 1.030
- Practice expense
- 1.196
- Malpractice
- 0.542
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.60 | × 1.030 | 2.6780 |
| Practice expense | 32.44 | × 1.196 | 38.7982 |
| Malpractice | 0.30 | × 0.542 | 0.1626 |
| Total RVUs | 41.6388 | ||
| Conversion factor | × 33.4009 | ||
Office rate, San Diego, CA$1390.77
Office: (2.6 × 1.03 + 32.44 × 1.196 + 0.3 × 0.542) × $33.4009 = $1390.77
Facility: (2.6 × 1.03 + 1.18 × 1.196 + 0.3 × 0.542) × $33.4009 = $142.02
Payment rules and modifiers for 43249
The CMS indicators that decide how 43249 is paid alongside other services.
CMS payment indicators · 43249
Esophageal dilation, balloon under 30 mm
| 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
43249 without 51 · national office
$1,180.39
Esophageal dilation, balloon under 30 mm
43249-51 · Second procedure: 50%
$590.20
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%).
How 43249 has changed in San Diego, CA
43249 · Office / nonfacility
$1390.77
Effective 2026-10-01
The base rate is $231.26 higher than on 2025-10-01, moving from $1159.51 to $1390.77 (19.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$1159.51changed to$1390.77
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 2.67 changed to 2.60
- Practice expense RVU 27.63 changed to 32.44
- Malpractice RVU 0.34 changed to 0.30
- Work GPCI 1.028 changed to 1.030
- Practice expense GPCI 1.191 changed to 1.196
- Malpractice GPCI 0.572 changed to 0.542
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$1248.75changed to$1159.51
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 29.03 changed to 27.63
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$1228.36changed to$1248.75
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$1283.43changed to$1228.36
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 29.69 changed to 29.03
- Work GPCI 1.032 changed to 1.028
- Practice expense GPCI 1.176 changed to 1.191
- Malpractice GPCI 0.596 changed to 0.572
January 1, 2023
RVU23A
$1351.94changed to$1283.43
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 31.12 changed to 29.69
- Malpractice RVU 0.32 changed to 0.34
- Work GPCI 1.037 changed to 1.032
- Practice expense GPCI 1.160 changed to 1.176
- Malpractice GPCI 0.620 changed to 0.596
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$1360.40changed to$1351.94
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 31.47 changed to 31.12
- Malpractice RVU 0.31 changed to 0.32
- Work GPCI 1.035 changed to 1.037
- Practice expense GPCI 1.145 changed to 1.160
- Malpractice GPCI 0.616 changed to 0.620
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$1250.96changed to$1360.40
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 28.07 changed to 31.47
- Work GPCI 1.032 changed to 1.035
- Practice expense GPCI 1.130 changed to 1.145
- Malpractice GPCI 0.607 changed to 0.616
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$1190.15changed to$1250.96
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 26.96 changed to 28.07
- Malpractice RVU 0.36 changed to 0.31
- Work GPCI 1.023 changed to 1.032
- Practice expense GPCI 1.116 changed to 1.130
- Malpractice GPCI 0.570 changed to 0.607
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$1137.23changed to$1190.15
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 26.01 changed to 26.96
- Malpractice RVU 0.35 changed to 0.36
- Work GPCI 1.022 changed to 1.023
- Practice expense GPCI 1.102 changed to 1.116
- Malpractice GPCI 0.567 changed to 0.570
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$1113.02changed to$1137.23
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 25.79 changed to 26.01
- Malpractice RVU 0.36 changed to 0.35
- Work GPCI 1.024 changed to 1.022
- Practice expense GPCI 1.088 changed to 1.102
- Malpractice GPCI 0.610 changed to 0.567
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$1113.02
Held through RVU17B, RVU17C, RVU17D.
January 1, 2014
RVU14A
No ratechanged toNo rate
Held through RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $1,390.77 | $142.02 | RVU26D |
| 2026-07-01 | $1,390.77 | $142.02 | RVU26C |
| 2026-04-01 | $1,390.77 | $142.02 | RVU26B |
| 2026-01-01 | $1,390.77 | $142.02 | RVU26A |
| 2025-10-01 | $1,159.51 | $154.40 | RVU25D |
| 2025-07-01 | $1,159.51 | $154.40 | RVU25C |
| 2025-04-01 | $1,159.51 | $154.40 | RVU25B |
| 2025-01-01 | $1,159.51 | $154.40 | RVU25A |
| 2024-10-01 | $1,248.75 | $158.50 | RVU24D |
| 2024-07-01 | $1,248.75 | $158.50 | RVU24C |
| 2024-04-01 | $1,248.75 | $158.50 | RVU24B |
| 2024-03-09 | $1,248.75 | $158.50 | RVU24AR |
| 2024-01-01 | $1,228.36 | $155.91 | RVU24A |
| 2023-10-01 | $1,283.43 | $160.02 | RVU23D |
| 2023-07-01 | $1,283.43 | $160.02 | RVU23C |
| 2023-04-01 | $1,283.43 | $160.02 | RVU23B |
| 2023-01-01 | $1,283.43 | $160.02 | RVU23A |
| 2022-10-01 | $1,351.94 | $162.90 | RVU22D |
| 2022-07-01 | $1,351.94 | $162.90 | RVU22C |
| 2022-04-01 | $1,351.94 | $162.90 | RVU22B |
| 2022-01-01 | $1,351.94 | $162.90 | RVU22A |
| 2021-10-01 | $1,360.40 | $162.62 | RVU21D |
| 2021-07-01 | $1,360.40 | $162.62 | RVU21C |
| 2021-04-01 | $1,360.40 | $162.62 | RVU21B |
| 2021-01-01 | $1,360.40 | $162.62 | RVU21A |
| 2020-10-01 | $1,250.96 | $164.96 | RVU20D |
| 2020-07-01 | $1,250.96 | $164.96 | RVU20C |
| 2020-04-01 | $1,250.96 | $164.96 | RVU20B |
| 2020-01-01 | $1,250.96 | $164.96 | RVU20A |
| 2019-10-01 | $1,190.15 | $164.55 | RVU19D |
| 2019-07-01 | $1,190.15 | $164.55 | RVU19C |
| 2019-04-01 | $1,190.15 | $164.55 | RVU19B |
| 2019-01-01 | $1,190.15 | $164.55 | RVU19A |
| 2018-10-01 | $1,137.23 | $164.09 | RVU18D |
| 2018-07-01 | $1,137.23 | $164.09 | RVU18C |
| 2018-04-01 | $1,137.23 | $164.09 | RVU18B |
| 2018-01-01 | $1,137.23 | $164.09 | RVU18AR1 |
| 2017-10-01 | $1,113.02 | $164.18 | RVU17D |
| 2017-07-01 | $1,113.02 | $164.18 | RVU17C |
| 2017-04-01 | $1,113.02 | $164.18 | RVU17B |
| 2017-01-01 | $1,113.02 | $164.18 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Not available in this setting | Rate data unavailable | RVU13D |
| 2013-07-01 | Not available in this setting | Rate data unavailable | RVU13C |
| 2013-04-01 | Not available in this setting | Rate data unavailable | RVU13B |
| 2013-01-01 | Not available in this setting | Rate data unavailable | RVU13AR |
Where the San Diego, CA rate applies
San Diego, CA is a Medicare payment area, not a city. Our Census mapping connects it to 57 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Carlsbad
- Chula Vista
- San Diego
- Vista
- Alpine
- Bonita
- Bonsall
- Borrego Springs
43249 billing questions
How does this differ from 43248?
43249 is for balloon dilation of the esophagus with a balloon under 30 mm. Use 43248 when dilation is performed over a guide wire.
Can this code be used for gastric outlet dilation?
No. This code is for dilation in the esophagus; 43245 describes dilation of the gastric outlet.
How many units should be reported if the balloon is inflated more than once?
Report the endoscopic dilation once for the session, not a separate unit for each inflation.
What documentation supports the code?
Document the esophageal narrowing, the balloon dilation technique, and the maximum balloon diameter used, which must be under 30 mm for this code.
Can modifier 50 be used, or can an assistant or co-surgeon be reported?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for it, and co-surgeon and team-surgery billing are not permitted.
Is same-day care included in the payment?
Yes. The 0-day global period includes same-day preoperative and postoperative care; related endoscopies performed together are subject to endoscopy-family pricing.
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
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