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

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 Dallas, TX, Medicare pays $211.10 for 43450 in the office and $72.71 when it’s performed in a hospital or facility.

$211.10Office (non-facility)
$72.71Hospital or facility
−0.5%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 Dallas, TX
  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 Dallas, TX 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. Dallas, TX pays $211.10. The RVUs are the same everywhere; the geographic indexes change the dollars.

43450 in Dallas, TX vs other payment areas
  1. Dallas, TX · this page$211.10
  2. Austin, TX · Texas$221.20+$10.10
  3. Beaumont, TX · Texas$196.86−$14.24
  4. Brazoria, TX · Texas$209.84−$1.26
  5. Fort Worth, TX · Texas$209.51−$1.59
  6. Galveston, TX · Texas$210.41−$0.69
  7. Houston, TX · Texas$213.16+$2.06

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

Every other payment area

43450 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$203.18$71.32
Los Angeles, CACalifornia$242.38$78.01
Washington, DC areaDistrict of Columbia$244.35$80.67
Miami, FLFlorida$226.53$81.89
Chicago, ILIllinois$219.70$80.06
Manhattan, NYNew York$244.49$83.03
AlaskaAlaska$241.47$93.49
AlabamaAlabama$189.25$67.68

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 Dallas, TX 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

99

Locality
Dallas, TX
Physician work
1.009
Practice expense
0.996
Malpractice
0.858
Office calculation for 43450 in Dallas, TX
ComponentRVULocality factorAdjusted
Physician work1.25× 1.0091.2612
Practice expense4.95× 0.9964.9302
Malpractice0.15× 0.8580.1287
Total RVUs6.3201
Conversion factor× 33.4009

Office rate, Dallas, TX$211.10

Office: (1.25 × 1.009 + 4.95 × 0.996 + 0.15 × 0.858) × $33.4009 = $211.10

Facility: (1.25 × 1.009 + 0.79 × 0.996 + 0.15 × 0.858) × $33.4009 = $72.71

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, Dallas, TX
Used instead
43453Esophageal dilation, balloon with fluoroscopyGuidewire-based esophageal dilation is reported here instead of unguided bougie passage.$828.12
43248Esophageal dilation, guidewire-assistedEndoscopic esophageal dilation using a guidewire, with upper GI endoscopy.$455.76
43249Esophageal dilation, balloon under 30 mmEndoscopic balloon dilation of the esophagus rather than unguided bougie dilation.$1,175.41

How 43450 has changed in Dallas, TX

43450 · Office / nonfacility

$211.10

Effective 2026-10-01

The base rate is $29.20 higher than on 2025-10-01, moving from $181.90 to $211.10 (16.1%).

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

    $181.90changed to$211.10

    • 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
    • Work GPCI 1.011 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.996
    • Malpractice GPCI 0.877 changed to 0.858

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $187.86changed to$181.90

    • 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

    $184.80changed to$187.86

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $192.61changed to$184.80

    • 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
    • Work GPCI 1.017 changed to 1.011
    • Practice expense GPCI 1.017 changed to 1.007
    • Malpractice GPCI 0.711 changed to 0.877

  5. January 1, 2023

    RVU23A

    $200.28changed to$192.61

    • 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
    • Work GPCI 1.023 changed to 1.017
    • Practice expense GPCI 1.026 changed to 1.017
    • Malpractice GPCI 0.546 changed to 0.711

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $198.19changed to$200.28

    • 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.

  7. January 1, 2021

    RVU21A

    $177.48changed to$198.19

    • 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
    • Work GPCI 1.018 changed to 1.023
    • Practice expense GPCI 1.020 changed to 1.026
    • Malpractice GPCI 0.657 changed to 0.546

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $170.16changed to$177.48

    • 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
    • Work GPCI 1.012 changed to 1.018
    • Practice expense GPCI 1.014 changed to 1.020
    • Malpractice GPCI 0.768 changed to 0.657

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $161.94changed to$170.16

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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $160.65changed to$161.94

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.01 changed to 3.03
    • Work GPCI 1.015 changed to 1.012
    • Practice expense GPCI 1.012 changed to 1.014
    • Malpractice GPCI 0.770 changed to 0.768

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $216.04changed to$160.65

    • 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
    • Work GPCI 1.018 changed to 1.015
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.772 changed to 0.770

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $220.55changed to$216.04

    • 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.

  13. July 1, 2015

    RVU15C

    $219.45changed to$220.55

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $218.02changed to$219.45

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.46 changed to 4.53
    • Work GPCI 1.014 changed to 1.018
    • Practice expense GPCI 1.013 changed to 1.009
    • Malpractice GPCI 0.803 changed to 0.772

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $162.27changed to$218.02

    • 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
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.017 changed to 1.013
    • Malpractice GPCI 0.834 changed to 0.803

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $162.27

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$211.10$72.71RVU26D
2026-07-01$211.10$72.71RVU26C
2026-04-01$211.10$72.71RVU26B
2026-01-01$211.10$72.71RVU26A
2025-10-01$181.90$77.02RVU25D
2025-07-01$181.90$77.02RVU25C
2025-04-01$181.90$77.02RVU25B
2025-01-01$181.90$77.02RVU25A
2024-10-01$187.86$78.92RVU24D
2024-07-01$187.86$78.92RVU24C
2024-04-01$187.86$78.92RVU24B
2024-03-09$187.86$78.92RVU24AR
2024-01-01$184.80$77.63RVU24A
2023-10-01$192.61$79.57RVU23D
2023-07-01$192.61$79.57RVU23C
2023-04-01$192.61$79.57RVU23B
2023-01-01$192.61$79.57RVU23A
2022-10-01$200.28$79.92RVU22D
2022-07-01$200.28$79.92RVU22C
2022-04-01$200.28$79.92RVU22B
2022-01-01$200.28$79.92RVU22A
2021-10-01$198.19$80.05RVU21D
2021-07-01$198.19$80.05RVU21C
2021-04-01$198.19$80.05RVU21B
2021-01-01$198.19$80.05RVU21A
2020-10-01$177.48$81.77RVU20D
2020-07-01$177.48$81.77RVU20C
2020-04-01$177.48$81.77RVU20B
2020-01-01$177.48$81.77RVU20A
2019-10-01$170.16$82.82RVU19D
2019-07-01$170.16$82.82RVU19C
2019-04-01$170.16$82.82RVU19B
2019-01-01$170.16$82.82RVU19A
2018-10-01$161.94$83.46RVU18D
2018-07-01$161.94$83.46RVU18C
2018-04-01$161.94$83.46RVU18B
2018-01-01$161.94$83.46RVU18AR1
2017-10-01$160.65$83.29RVU17D
2017-07-01$160.65$83.29RVU17C
2017-04-01$160.65$83.29RVU17B
2017-01-01$160.65$83.29RVU17A
2016-10-01$216.04$88.51RVU16D
2016-07-01$216.04$88.51RVU16C
2016-04-01$216.04$88.51RVU16B
2016-01-01$216.04$88.51RVU16A
2015-10-01$220.55$90.75RVU15D
2015-07-01$220.55$90.75RVU15C
2015-04-01$219.45$90.30RVU15B
2015-01-01$219.45$90.30RVU15A
2014-10-01$218.02$90.64RVU14D
2014-07-01$218.02$90.64RVU14C
2014-04-01$218.02$90.64RVU14B
2014-01-01$218.02$90.64RVU14A
2013-10-01$162.27$90.99RVU13D
2013-07-01$162.27$90.99RVU13C
2013-04-01$162.27$90.99RVU13B
2013-01-01$162.27$90.99RVU13AR

Price 43450 for an earlier date of service

Where the Dallas, TX rate applies

Dallas, TX is a Medicare payment area, not a city. Our Census mapping connects it to 32 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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 Dallas, TXGPCI2026.csv, line 99 (RVU26D)

Open CMS sourceHow we calculate rates

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