CPT code 43450: Esophageal dilation, unguided sound or bougie2026 Medicare rate & RVUs in California
Unguided bougie or sound dilation treats esophageal narrowing, with one or multiple passes reported as a single service during the session.
Medicare pays $226.35–$287.44 for 43450 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 43450 covers
This service enlarges a narrowed esophageal lumen by passing an unguided tapered sound or bougie through the mouth into the esophagus. Gastroenterologists and other physicians commonly perform it for dysphagia caused by narrowing, such as a benign stricture or ring, in an endoscopy unit, ambulatory surgery center, or hospital. The instrument is passed without a guidewire; one or several passes during the session are part of the same dilation service.
Choose 43450 for unguided sound or bougie dilation. Use 43453 for dilation over a guidewire, and compare endoscopic dilation codes when the procedure uses endoscopic guidance. Document the indication, narrowed site, technique, instrument, and passes. The CMS 0-day global period includes same-day preoperative and postoperative care. When eligible procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Medicare does not pay for an assistant at surgery for this service; co-surgeon and team-surgery reporting 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.
Where 43450 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$226.35 to $287.44
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $226.80 | $74.52 |
| Chico, CA | $226.35 | $74.07 |
| El Centro, CA | $226.38 | $74.09 |
| Fresno, CA | $226.35 | $74.07 |
| Hanford, CA | $226.35 | $74.07 |
| Los Angeles, CA | $242.38 | $78.01 |
| Madera, CA | $226.35 | $74.07 |
| Marin County, CA | $281.14 | $85.22 |
| Merced, CA | $226.35 | $74.07 |
| Modesto, CA | $226.35 | $74.07 |
| Napa, CA | $264.84 | $81.70 |
| Oxnard, CA | $241.47 | $77.23 |
| Redding, CA | $226.35 | $74.07 |
| Rest of California | $226.35 | $74.07 |
| Riverside, CA | $227.98 | $75.70 |
| Sacramento, CA | $238.22 | $76.63 |
| Salinas, CA | $237.35 | $76.31 |
| San Benito County, CA | $287.44 | $87.08 |
| San Diego, CA | $243.46 | $77.28 |
| San Francisco, CA | $280.97 | $85.05 |
| San Luis Obispo, CA | $233.46 | $75.20 |
| Santa Clara County, CA | $286.75 | $86.38 |
| Santa Cruz, CA | $246.19 | $77.37 |
| Santa Maria, CA | $238.39 | $76.37 |
| Santa Rosa, CA | $248.72 | $78.09 |
| Stockton, CA | $226.35 | $74.07 |
| Vallejo, CA | $264.59 | $81.46 |
| Visalia, CA | $226.35 | $74.07 |
| Yuba City, CA | $226.35 | $74.07 |
How the 43450 rate is calculated
Each of 43450’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 · 43450
RVUs × geographic indexes × conversion factor
Work1.25
1.25 RVUs× 1.000 GPCI
Practice expense4.95
4.95 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
6.3500
Conversion factor
$33.4009
Medicare rate
$212.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43450
The CMS indicators that decide how 43450 is paid alongside other services.
CMS payment indicators · 43450
Esophageal dilation, unguided sound or bougie
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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
43450 without 51 · national office
$212.10
Esophageal dilation, unguided sound or bougie
43450-51 · Second procedure: 50%
$106.05
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%).
43450 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43453Esophageal dilationBalloon with fluoroscopy
- Use 43450 for unguided sound or bougie passage. Use 43453 when dilation is performed over a guidewire.
- 43248Esophageal dilationGuidewire-assisted
- 43248 includes upper GI endoscopy with guidewire dilation. 43450 describes unguided sound or bougie dilation.
- 43249Esophageal dilationBalloon under 30 mm
- 43249 is for endoscopic balloon dilation of the esophagus. 43450 is for dilation with an unguided sound or bougie.
43450 billing questions
How does 43450 differ from 43453?
43450 describes unguided sound or bougie dilation. When dilation is performed over a guidewire, use 43453.
Is each bougie pass reported as a separate unit?
No. The service includes one or multiple passes during the session; do not report a separate unit for each pass.
Can 43450 be reported for endoscopic balloon dilation?
No. 43450 is for unguided sound or bougie dilation. Endoscopic balloon dilation is represented by a different procedure code.
What documentation supports reporting 43450?
Document the reason for dilation, the esophageal narrowing treated, and that an unguided sound or bougie was used. Record the number of passes as part of the procedure details.
How does the 0-day global period affect the claim?
Same-day preoperative and postoperative care is included in the procedure's global period.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other eligible procedures are paid at 50%.
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.
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