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CPT code 43249: Esophageal dilation, balloon under 30 mm2026 Medicare rate & RVUs in Santa Clara County, CA

Reports upper endoscopy with balloon dilation of an esophageal narrowing using a balloon diameter under 30 mm, commonly to relieve dysphagia.

CMS RVU26DEffective Oct 1, 2026One payment locality164.8K Medicare services in 2024

In Santa Clara County, CA, Medicare pays $1,662.82 for 43249 in the office and $157.21 when it’s performed in a hospital or facility.

$1,662.82Office (non-facility)
$157.21Hospital or facility
+40.9%vs the national office rate ($1,180.39)

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.

We’ll open 43249 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Santa Clara County, CA
  2. What 43249 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 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 Santa Clara County, 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. Santa Clara County, CA pays $1,662.82. The RVUs are the same everywhere; the geographic indexes change the dollars.

43249 in Santa Clara County, CA vs other payment areas
  1. Santa Clara County, CA · this page$1,662.82
  2. Bakersfield, CA · California$1,282.14−$380.68
  3. Chico, CA · California$1,281.23−$381.59
  4. El Centro, CA · California$1,281.28−$381.54
  5. Fresno, CA · California$1,281.23−$381.59
  6. Hanford, CA · California$1,281.23−$381.59
  7. Los Angeles, CA · California$1,378.87−$283.95

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

Every other payment area

43249 in every other Medicare payment locality
Payment localityOfficeFacility
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

43249 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.

$1,022.75

$1,472.72

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

View every state and territory as a table
43249 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,289.741
AL$1,040.601
AR$1,022.751
AZ$1,145.361
CA$1,281.23–$1,664.2129
CO$1,248.581
CT$1,267.661
DC$1,379.081
DE$1,166.811
FL$1,137.75–$1,240.133
GA$1,065.29–$1,200.002
GU$1,324.611
HI$1,324.611
IA$1,082.251
ID$1,088.431
IL$1,091.76–$1,217.994
IN$1,096.141
KS$1,071.401
KY$1,059.261
LA$1,055.36–$1,117.822
MA$1,237.17–$1,393.052
MD$1,193.44–$1,379.083
ME$1,089.92–$1,166.942
MI$1,087.41–$1,149.342
MN$1,204.761
MO$1,030.60–$1,128.403
MS$1,027.161
MT$1,180.371
NC$1,104.171
ND$1,174.441
NE$1,090.721
NH$1,223.561
NJ$1,284.52–$1,359.902
NM$1,092.471
NV$1,179.801
NY$1,123.24–$1,399.325
OH$1,086.201
OK$1,062.221
OR$1,173.08–$1,299.482
PA$1,090.99–$1,228.312
PR$1,192.161
RI$1,216.711
SC$1,096.541
SD$1,173.731
TN$1,077.151
TX$1,082.16–$1,242.268
UT$1,114.351
VA$1,159.02–$1,379.082
VI$1,192.161
VT$1,164.601
WA$1,236.55–$1,428.862
WI$1,127.951
WV$1,042.761
WY$1,177.781

See 43249 in every payment locality

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

Office or facility?

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 Santa Clara County, 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

28

Locality
Santa Clara County, CA
Physician work
1.110
Practice expense
1.442
Malpractice
0.397
Office calculation for 43249 in Santa Clara County, CA
ComponentRVULocality factorAdjusted
Physician work2.60× 1.1102.8860
Practice expense32.44× 1.44246.7785
Malpractice0.30× 0.3970.1191
Total RVUs49.7836
Conversion factor× 33.4009

Office rate, Santa Clara County, CA$1662.82

Office: (2.6 × 1.11 + 32.44 × 1.442 + 0.3 × 0.397) × $33.4009 = $1662.82

Facility: (2.6 × 1.11 + 1.18 × 1.442 + 0.3 × 0.397) × $33.4009 = $157.21

Open 43249 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 43249

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

Codes related to 43249
CodeHow it relatesOffice range, Santa Clara County, CA
Used instead
43248Esophageal dilation, guidewire-assistedEsophageal dilation performed over a guide wire rather than with the balloon technique represented by this code.$616.97
43245EGD dilation, gastric outlet obstructionDilation at the gastric outlet, rather than dilation of an esophageal narrowing.$896.57
Often billed with
43239EGD with biopsy, single or multiple biopsiesMay accompany dilation when a separate biopsy is performed; endoscopy-family pricing applies to related endoscopies.$568.72

How 43249 has changed in Santa Clara County, CA

43249 · Office / nonfacility

$1662.82

Effective 2026-10-01

The base rate is $280.69 higher than on 2025-10-01, moving from $1382.13 to $1662.82 (20.3%).

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

    $1382.13changed to$1662.82

    • 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 1.100 changed to 1.110
    • Practice expense GPCI 1.435 changed to 1.442
    • Malpractice GPCI 0.420 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1489.21changed to$1382.13

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 29.03 changed to 27.63

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1464.91changed to$1489.21

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1521.76changed to$1464.91

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 29.69 changed to 29.03
    • Work GPCI 1.098 changed to 1.100
    • Practice expense GPCI 1.409 changed to 1.435
    • Malpractice GPCI 0.417 changed to 0.420

  5. January 1, 2023

    RVU23A

    $1595.27changed to$1521.76

    • 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 1.096 changed to 1.098
    • Practice expense GPCI 1.383 changed to 1.409
    • Malpractice GPCI 0.414 changed to 0.417

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1625.24changed to$1595.27

    • 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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $1496.27changed to$1625.24

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 28.07 changed to 31.47
    • Work GPCI 1.089 changed to 1.096
    • Practice expense GPCI 1.369 changed to 1.383
    • Malpractice GPCI 0.401 changed to 0.414

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1424.81changed to$1496.27

    • 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 1.083 changed to 1.089
    • Practice expense GPCI 1.354 changed to 1.369
    • Malpractice GPCI 0.388 changed to 0.401

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $1376.80changed to$1424.81

    • 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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $1359.70changed to$1376.80

    • 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 1.086 changed to 1.083
    • Practice expense GPCI 1.351 changed to 1.354
    • Malpractice GPCI 0.402 changed to 0.388

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1431.02changed to$1359.70

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.77 changed to 2.67
    • Practice expense RVU 27.32 changed to 25.79
    • Malpractice RVU 0.37 changed to 0.36
    • Work GPCI 1.088 changed to 1.086
    • Practice expense GPCI 1.347 changed to 1.351
    • Malpractice GPCI 0.416 changed to 0.402

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1462.43changed to$1431.02

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 27.85 changed to 27.32
    • Malpractice RVU 0.41 changed to 0.37

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $1455.15changed to$1462.43

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1394.02changed to$1455.15

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 26.63 changed to 27.85
    • Malpractice RVU 0.38 changed to 0.41
    • Work GPCI 1.083 changed to 1.088
    • Practice expense GPCI 1.342 changed to 1.347
    • Malpractice GPCI 0.466 changed to 0.416

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$1394.02

    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$1,662.82$157.21RVU26D
2026-07-01$1,662.82$157.21RVU26C
2026-04-01$1,662.82$157.21RVU26B
2026-01-01$1,662.82$157.21RVU26A
2025-10-01$1,382.13$171.10RVU25D
2025-07-01$1,382.13$171.10RVU25C
2025-04-01$1,382.13$171.10RVU25B
2025-01-01$1,382.13$171.10RVU25A
2024-10-01$1,489.21$175.60RVU24D
2024-07-01$1,489.21$175.60RVU24C
2024-04-01$1,489.21$175.60RVU24B
2024-03-09$1,489.21$175.60RVU24AR
2024-01-01$1,464.91$172.74RVU24A
2023-10-01$1,521.76$175.77RVU23D
2023-07-01$1,521.76$175.77RVU23C
2023-04-01$1,521.76$175.77RVU23B
2023-01-01$1,521.76$175.77RVU23A
2022-10-01$1,595.27$177.64RVU22D
2022-07-01$1,595.27$177.64RVU22C
2022-04-01$1,595.27$177.64RVU22B
2022-01-01$1,595.27$177.64RVU22A
2021-10-01$1,625.24$178.49RVU21D
2021-07-01$1,625.24$178.49RVU21C
2021-04-01$1,625.24$178.49RVU21B
2021-01-01$1,625.24$178.49RVU21A
2020-10-01$1,496.27$180.57RVU20D
2020-07-01$1,496.27$180.57RVU20C
2020-04-01$1,496.27$180.57RVU20B
2020-01-01$1,496.27$180.57RVU20A
2019-10-01$1,424.81$180.49RVU19D
2019-07-01$1,424.81$180.49RVU19C
2019-04-01$1,424.81$180.49RVU19B
2019-01-01$1,424.81$180.49RVU19A
2018-10-01$1,376.80$181.13RVU18D
2018-07-01$1,376.80$181.13RVU18C
2018-04-01$1,376.80$181.13RVU18B
2018-01-01$1,376.80$181.13RVU18AR1
2017-10-01$1,359.70$181.50RVU17D
2017-07-01$1,359.70$181.50RVU17C
2017-04-01$1,359.70$181.50RVU17B
2017-01-01$1,359.70$181.50RVU17A
2016-10-01$1,431.02$186.72RVU16D
2016-07-01$1,431.02$186.72RVU16C
2016-04-01$1,431.02$186.72RVU16B
2016-01-01$1,431.02$186.72RVU16A
2015-10-01$1,462.43$190.42RVU15D
2015-07-01$1,462.43$190.42RVU15C
2015-04-01$1,455.15$189.47RVU15B
2015-01-01$1,455.15$189.47RVU15A
2014-10-01$1,394.02$189.77RVU14D
2014-07-01$1,394.02$189.77RVU14C
2014-04-01$1,394.02$189.77RVU14B
2014-01-01$1,394.02$189.77RVU14A
2013-10-01Not available in this setting$198.25RVU13D
2013-07-01Not available in this settingRate data unavailableRVU13C
2013-04-01Not available in this settingRate data unavailableRVU13B
2013-01-01Not available in this settingRate data unavailableRVU13AR

Price 43249 for an earlier date of service

Where the Santa Clara County, CA rate applies

Santa Clara County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 24 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • San Jose
  • Santa Clara
  • Sunnyvale
  • Alum Rock
  • Burbank
  • Cambrian Park
  • Campbell
  • Cupertino

Browse all communities in California

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
RVUs for 43249PPRRVU2026_Oct_nonQPP.csv, line 5,177 (RVU26D)
Geographic factors for Santa Clara County, CAGPCI2026.csv, line 28 (RVU26D)

Open CMS sourceHow we calculate rates

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