CPT code 43249: Esophageal dilation, balloon under 30 mm2026 Medicare rate & RVUs in South Dakota
Reports upper endoscopy with balloon dilation of an esophageal narrowing using a balloon diameter under 30 mm, commonly to relieve dysphagia.
In South Dakota, Medicare pays $1,173.73 for 43249 in the office and $129.62 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 South Dakota 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. South Dakota pays $1,173.73. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$1,173.73
- Los Angeles, CA · California$1,378.87+$205.14
- Washington, DC area · District of Columbia$1,379.08+$205.35
- Miami, FL · Florida$1,240.13+$66.40
- Chicago, IL · Illinois$1,199.39+$25.66
- Manhattan, NY · New York$1,367.35+$193.62
- Alaska · Alaska$1,289.74+$116.01
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $1,040.60 | $127.00 |
| ArkansasArkansas | $1,022.75 | $125.86 |
| ArizonaArizona | $1,145.36 | $133.61 |
| Bakersfield, CACalifornia | $1,282.14 | $137.79 |
| Chico, CACalifornia | $1,281.23 | $136.89 |
| El Centro, CACalifornia | $1,281.28 | $136.94 |
| Fresno, CACalifornia | $1,281.23 | $136.89 |
| Hanford, CACalifornia | $1,281.23 | $136.89 |
| 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 |
| San Diego, CACalifornia | $1,390.77 | $142.02 |
| 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 |
| 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 |
| 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 South Dakota 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
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.60 | × 1.000 | 2.6000 |
| Practice expense | 32.44 | × 1.000 | 32.4400 |
| Malpractice | 0.30 | × 0.336 | 0.1008 |
| Total RVUs | 35.1408 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$1173.73
Office: (2.6 × 1 + 32.44 × 1 + 0.3 × 0.336) × $33.4009 = $1173.73
Facility: (2.6 × 1 + 1.18 × 1 + 0.3 × 0.336) × $33.4009 = $129.62
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 South Dakota
43249 · Office / nonfacility
$1173.73
Effective 2026-10-01
The base rate is $189.43 higher than on 2025-10-01, moving from $984.30 to $1173.73 (19.2%).
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
$984.30changed to$1173.73
- 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
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$1059.54changed to$984.30
- 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
$1042.24changed to$1059.54
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$1100.78changed to$1042.24
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 29.69 changed to 29.03
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$1173.19changed to$1100.78
- 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
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$1195.00changed to$1173.19
- 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.
January 1, 2021
RVU21A
$1113.51changed to$1195.00
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 28.07 changed to 31.47
- Malpractice GPCI 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$1072.89changed to$1113.51
- 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
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$1037.37changed to$1072.89
- 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.
January 1, 2018
RVU18AR1
$1026.50changed to$1037.37
- 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
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$1082.65changed to$1026.50
- 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
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$1106.18changed to$1082.65
- 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.
July 1, 2015
RVU15C
$1100.67changed to$1106.18
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$1058.85changed to$1100.67
- 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
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$1058.85
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $1,173.73 | $129.62 | RVU26D |
| 2026-07-01 | $1,173.73 | $129.62 | RVU26C |
| 2026-04-01 | $1,173.73 | $129.62 | RVU26B |
| 2026-01-01 | $1,173.73 | $129.62 | RVU26A |
| 2025-10-01 | $984.30 | $140.38 | RVU25D |
| 2025-07-01 | $984.30 | $140.38 | RVU25C |
| 2025-04-01 | $984.30 | $140.38 | RVU25B |
| 2025-01-01 | $984.30 | $140.38 | RVU25A |
| 2024-10-01 | $1,059.54 | $144.13 | RVU24D |
| 2024-07-01 | $1,059.54 | $144.13 | RVU24C |
| 2024-04-01 | $1,059.54 | $144.13 | RVU24B |
| 2024-03-09 | $1,059.54 | $144.13 | RVU24AR |
| 2024-01-01 | $1,042.24 | $141.78 | RVU24A |
| 2023-10-01 | $1,100.78 | $145.50 | RVU23D |
| 2023-07-01 | $1,100.78 | $145.50 | RVU23C |
| 2023-04-01 | $1,100.78 | $145.50 | RVU23B |
| 2023-01-01 | $1,100.78 | $145.50 | RVU23A |
| 2022-10-01 | $1,173.19 | $148.15 | RVU22D |
| 2022-07-01 | $1,173.19 | $148.15 | RVU22C |
| 2022-04-01 | $1,173.19 | $148.15 | RVU22B |
| 2022-01-01 | $1,173.19 | $148.15 | RVU22A |
| 2021-10-01 | $1,195.00 | $148.91 | RVU21D |
| 2021-07-01 | $1,195.00 | $148.91 | RVU21C |
| 2021-04-01 | $1,195.00 | $148.91 | RVU21B |
| 2021-01-01 | $1,195.00 | $148.91 | RVU21A |
| 2020-10-01 | $1,113.51 | $152.45 | RVU20D |
| 2020-07-01 | $1,113.51 | $152.45 | RVU20C |
| 2020-04-01 | $1,113.51 | $152.45 | RVU20B |
| 2020-01-01 | $1,113.51 | $152.45 | RVU20A |
| 2019-10-01 | $1,072.89 | $153.89 | RVU19D |
| 2019-07-01 | $1,072.89 | $153.89 | RVU19C |
| 2019-04-01 | $1,072.89 | $153.89 | RVU19B |
| 2019-01-01 | $1,072.89 | $153.89 | RVU19A |
| 2018-10-01 | $1,037.37 | $154.30 | RVU18D |
| 2018-07-01 | $1,037.37 | $154.30 | RVU18C |
| 2018-04-01 | $1,037.37 | $154.30 | RVU18B |
| 2018-01-01 | $1,037.37 | $154.30 | RVU18AR1 |
| 2017-10-01 | $1,026.50 | $154.40 | RVU17D |
| 2017-07-01 | $1,026.50 | $154.40 | RVU17C |
| 2017-04-01 | $1,026.50 | $154.40 | RVU17B |
| 2017-01-01 | $1,026.50 | $154.40 | RVU17A |
| 2016-10-01 | $1,082.65 | $158.90 | RVU16D |
| 2016-07-01 | $1,082.65 | $158.90 | RVU16C |
| 2016-04-01 | $1,082.65 | $158.90 | RVU16B |
| 2016-01-01 | $1,082.65 | $158.90 | RVU16A |
| 2015-10-01 | $1,106.18 | $161.84 | RVU15D |
| 2015-07-01 | $1,106.18 | $161.84 | RVU15C |
| 2015-04-01 | $1,100.67 | $161.04 | RVU15B |
| 2015-01-01 | $1,100.67 | $161.04 | RVU15A |
| 2014-10-01 | $1,058.85 | $161.49 | RVU14D |
| 2014-07-01 | $1,058.85 | $161.49 | RVU14C |
| 2014-04-01 | $1,058.85 | $161.49 | RVU14B |
| 2014-01-01 | $1,058.85 | $161.49 | RVU14A |
| 2013-10-01 | Not available in this setting | $168.12 | RVU13D |
| 2013-07-01 | Not available in this setting | $168.12 | RVU13C |
| 2013-04-01 | Not available in this setting | $168.12 | RVU13B |
| 2013-01-01 | Not available in this setting | $168.12 | RVU13AR |
Where the South Dakota rate applies
South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Agar
- Agency Village
- Akaska
- Albee
- Alcester
- Alexandria
- Allen
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
Fee sheets
Put 43249 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet