FeeBase
Log inGet started
Menu

CPT code 43450: Esophageal dilation, unguided sound or bougie2026 Medicare rate & RVUs in Puerto Rico

Unguided bougie or sound dilation treats esophageal narrowing, with one or multiple passes reported as a single service during the session.

CMS RVU26DEffective Oct 1, 2026One payment locality79.4K Medicare services in 2024

In Puerto Rico, Medicare pays $213.84 for 43450 in the office and $73.36 when it’s performed in a hospital or facility.

$213.84Office (non-facility)
$73.36Hospital or facility
+0.8%vs the national office rate ($212.10)

Check a contract rate as a % of Medicare · 43450 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 43450 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 43450 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 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.

How Puerto Rico compares for 43450

Across 109 of 109 payment localities, the office rate for 43450 runs from $186.35 in Arkansas to $287.44 in San Benito County, CA. Puerto Rico pays $213.84. The RVUs are the same everywhere; the geographic indexes change the dollars.

43450 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$213.84
  2. Los Angeles, CA · California$242.38+$28.54
  3. Washington, DC area · District of Columbia$244.35+$30.51
  4. Miami, FL · Florida$226.53+$12.69
  5. Chicago, IL · Illinois$219.70+$5.86
  6. Manhattan, NY · New York$244.49+$30.65
  7. Alaska · Alaska$241.47+$27.63

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

Every other payment area

43450 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$189.25$67.68
ArkansasArkansas$186.35$67.00
ArizonaArizona$206.25$71.61
Bakersfield, CACalifornia$226.80$74.52
Chico, CACalifornia$226.35$74.07
El Centro, CACalifornia$226.38$74.09
Fresno, CACalifornia$226.35$74.07
Hanford, CACalifornia$226.35$74.07

43450 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.

$186.35

$256.90

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

View every state and territory as a table
43450 office rate range by state
State / territoryOffice rate rangeLocalities
AK$241.471
AL$189.251
AR$186.351
AZ$206.251
CA$226.35–$287.4429
CO$222.081
CT$226.711
DC$244.351
DE$209.811
FL$207.34–$226.533
GA$195.20–$215.872
GU$232.641
HI$232.641
IA$195.021
ID$196.231
IL$200.53–$220.724
IN$197.451
KS$193.741
KY$193.321
LA$192.87–$203.022
MA$220.51–$245.332
MD$214.09–$244.353
ME$196.98–$208.762
MI$198.36–$209.752
MN$213.361
MO$189.15–$204.173
MS$187.811
MT$212.091
NC$199.211
ND$209.121
NE$196.251
NH$218.251
NJ$229.46–$241.522
NM$199.381
NV$211.421
NY$202.34–$250.315
OH$197.751
OK$193.291
OR$209.95–$229.832
PA$198.26–$220.592
PR$213.841
RI$217.801
SC$198.781
SD$208.771
TN$194.731
TX$196.86–$221.208
UT$201.661
VA$207.81–$244.352
VI$213.841
VT$207.971
WA$220.20–$250.802
WI$201.681
WV$192.601
WY$210.791

See 43450 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,250

Code
43450
Physician work
1.25
Practice expense
4.95
Malpractice
0.15

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 43450 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.25× 1.0001.2500
Practice expense4.95× 1.0115.0044
Malpractice0.15× 0.9850.1477
Total RVUs6.4022
Conversion factor× 33.4009

Office rate, Puerto Rico$213.84

Office: (1.25 × 1 + 4.95 × 1.011 + 0.15 × 0.985) × $33.4009 = $213.84

Facility: (1.25 × 1 + 0.79 × 1.011 + 0.15 × 0.985) × $33.4009 = $73.36

Open 43450 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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

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%).

When to use modifier 51

Codes related to 43450

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

Codes related to 43450
CodeHow it relatesOffice range, Puerto Rico
Used instead
43453Esophageal dilation, balloon with fluoroscopyGuidewire-based esophageal dilation is reported here instead of unguided bougie passage.$840.17
43248Esophageal dilation, guidewire-assistedEndoscopic esophageal dilation using a guidewire, with upper GI endoscopy.$461.62
43249Esophageal dilation, balloon under 30 mmEndoscopic balloon dilation of the esophagus rather than unguided bougie dilation.$1,192.16

How 43450 has changed in Puerto Rico

43450 · Office / nonfacility

$213.84

Effective 2026-10-01

The base rate is $31.85 higher than on 2025-10-01, moving from $181.99 to $213.84 (17.5%).

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

    $181.99changed to$213.84

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.28 changed to 1.25
    • Practice expense RVU 4.16 changed to 4.95
    • Malpractice RVU 0.16 changed to 0.15
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $187.95changed to$181.99

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.18 changed to 4.16

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $184.89changed to$187.95

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $192.17changed to$184.89

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.19 changed to 4.18
    • Malpractice RVU 0.17 changed to 0.16
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $191.12changed to$192.17

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $198.72changed to$191.12

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.29 changed to 4.19
    • Malpractice RVU 0.14 changed to 0.17
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $196.84changed to$198.72

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.18 changed to 4.29
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $176.70changed to$196.84

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.46 changed to 4.18
    • Malpractice RVU 0.13 changed to 0.15
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $170.14changed to$176.70

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.25 changed to 3.46
    • Malpractice RVU 0.17 changed to 0.13
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $161.98changed to$170.14

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.03 changed to 3.25

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $142.32changed to$161.98

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.01 changed to 3.03
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $163.63changed to$142.32

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 1.38 changed to 1.28
    • Practice expense RVU 4.45 changed to 3.01
    • Malpractice RVU 0.18 changed to 0.17
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $166.56changed to$163.63

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.53 changed to 4.45
    • Malpractice RVU 0.21 changed to 0.18

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $165.73changed to$166.56

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $162.03changed to$165.73

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.46 changed to 4.53
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $121.25changed to$162.03

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.14 changed to 4.46
    • Malpractice RVU 0.22 changed to 0.21
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $121.25

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$213.84$73.36RVU26D
2026-07-01$213.84$73.36RVU26C
2026-04-01$213.84$73.36RVU26B
2026-01-01$213.84$73.36RVU26A
2025-10-01$181.99$77.10RVU25D
2025-07-01$181.99$77.10RVU25C
2025-04-01$181.99$77.10RVU25B
2025-01-01$181.99$77.10RVU25A
2024-10-01$187.95$79.01RVU24D
2024-07-01$187.95$79.01RVU24C
2024-04-01$187.95$79.01RVU24B
2024-03-09$187.95$79.01RVU24AR
2024-01-01$184.89$77.72RVU24A
2023-10-01$192.17$80.13RVU23D
2023-07-01$191.12$79.97RVU23C
2023-04-01$191.12$79.97RVU23B
2023-01-01$191.12$79.97RVU23A
2022-10-01$198.72$80.47RVU22D
2022-07-01$198.72$80.47RVU22C
2022-04-01$198.72$80.47RVU22B
2022-01-01$198.72$80.47RVU22A
2021-10-01$196.84$80.78RVU21D
2021-07-01$196.84$80.78RVU21C
2021-04-01$196.84$80.78RVU21B
2021-01-01$196.84$80.78RVU21A
2020-10-01$176.70$82.12RVU20D
2020-07-01$176.70$82.12RVU20C
2020-04-01$176.70$82.12RVU20B
2020-01-01$176.70$82.12RVU20A
2019-10-01$170.14$83.41RVU19D
2019-07-01$170.14$83.41RVU19C
2019-04-01$170.14$83.41RVU19B
2019-01-01$170.14$83.41RVU19A
2018-10-01$161.98$84.04RVU18D
2018-07-01$161.98$84.04RVU18C
2018-04-01$161.98$84.04RVU18B
2018-01-01$161.98$84.04RVU18AR1
2017-10-01$142.32$76.89RVU17D
2017-07-01$142.32$76.89RVU17C
2017-04-01$142.32$76.89RVU17B
2017-01-01$142.32$76.89RVU17A
2016-10-01$163.63$74.52RVU16D
2016-07-01$163.63$74.52RVU16C
2016-04-01$163.63$74.52RVU16B
2016-01-01$163.63$74.52RVU16A
2015-10-01$166.56$75.87RVU15D
2015-07-01$166.56$75.87RVU15C
2015-04-01$165.73$75.49RVU15B
2015-01-01$165.73$75.49RVU15A
2014-10-01$162.03$75.02RVU14D
2014-07-01$162.03$75.02RVU14C
2014-04-01$162.03$75.02RVU14B
2014-01-01$162.03$75.02RVU14A
2013-10-01$121.25$73.73RVU13D
2013-07-01$121.25$73.73RVU13C
2013-04-01$121.25$73.73RVU13B
2013-01-01$121.25$73.73RVU13AR

Price 43450 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 43450PPRRVU2026_Oct_nonQPP.csv, line 5,250 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 43450 pays in Puerto Rico?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 43450 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist