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

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 Virginia, Medicare pays $207.81 for 43450 in the office and $71.23 when it’s performed in a hospital or facility.

$207.81Office (non-facility)
$71.23Hospital or facility
−2.0%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 Virginia
  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 Virginia 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. Virginia pays $207.81. The RVUs are the same everywhere; the geographic indexes change the dollars.

43450 in Virginia vs other payment areas
  1. Virginia · this page$207.81
  2. Los Angeles, CA · California$242.38+$34.57
  3. Washington, DC area · District of Columbia$244.35+$36.54
  4. Miami, FL · Florida$226.53+$18.72
  5. Chicago, IL · Illinois$219.70+$11.89
  6. Manhattan, NY · New York$244.49+$36.68
  7. Alaska · Alaska$241.47+$33.66

Other areas in Virginia 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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 43450 in Virginia
ComponentRVULocality factorAdjusted
Physician work1.25× 1.0001.2500
Practice expense4.95× 0.9834.8659
Malpractice0.15× 0.7060.1059
Total RVUs6.2218
Conversion factor× 33.4009

Office rate, Virginia$207.81

Office: (1.25 × 1 + 4.95 × 0.983 + 0.15 × 0.706) × $33.4009 = $207.81

Facility: (1.25 × 1 + 0.79 × 0.983 + 0.15 × 0.706) × $33.4009 = $71.23

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, Virginia
Used instead
43453Esophageal dilation, balloon with fluoroscopyGuidewire-based esophageal dilation is reported here instead of unguided bougie passage.$816.66
43248Esophageal dilation, guidewire-assistedEndoscopic esophageal dilation using a guidewire, with upper GI endoscopy.$448.61
43249Esophageal dilation, balloon under 30 mmEndoscopic balloon dilation of the esophagus rather than unguided bougie dilation.$1,159.02

How 43450 has changed in Virginia

43450 · Office / nonfacility

$207.81

Effective 2026-10-01

The base rate is $30.01 higher than on 2025-10-01, moving from $177.80 to $207.81 (16.9%).

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

    $177.80changed to$207.81

    • 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 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $183.63changed to$177.80

    • 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

    $180.63changed to$183.63

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $188.70changed to$180.63

    • 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 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $196.36changed to$188.70

    • 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 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $194.48changed to$196.36

    • 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

    $174.18changed to$194.48

    • 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
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $167.18changed to$174.18

    • 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 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $159.19changed to$167.18

    • 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

    $157.63changed to$159.19

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.01 changed to 3.03
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $211.34changed to$157.63

    • 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 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $215.82changed to$211.34

    • 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

    $214.74changed to$215.82

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $211.86changed to$214.74

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.46 changed to 4.53
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $156.80changed to$211.86

    • 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 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $156.80

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$207.81$71.23RVU26D
2026-07-01$207.81$71.23RVU26C
2026-04-01$207.81$71.23RVU26B
2026-01-01$207.81$71.23RVU26A
2025-10-01$177.80$75.31RVU25D
2025-07-01$177.80$75.31RVU25C
2025-04-01$177.80$75.31RVU25B
2025-01-01$177.80$75.31RVU25A
2024-10-01$183.63$77.18RVU24D
2024-07-01$183.63$77.18RVU24C
2024-04-01$183.63$77.18RVU24B
2024-03-09$183.63$77.18RVU24AR
2024-01-01$180.63$75.92RVU24A
2023-10-01$188.70$78.66RVU23D
2023-07-01$188.70$78.66RVU23C
2023-04-01$188.70$78.66RVU23B
2023-01-01$188.70$78.66RVU23A
2022-10-01$196.36$79.63RVU22D
2022-07-01$196.36$79.63RVU22C
2022-04-01$196.36$79.63RVU22B
2022-01-01$196.36$79.63RVU22A
2021-10-01$194.48$79.91RVU21D
2021-07-01$194.48$79.91RVU21C
2021-04-01$194.48$79.91RVU21B
2021-01-01$194.48$79.91RVU21A
2020-10-01$174.18$81.19RVU20D
2020-07-01$174.18$81.19RVU20C
2020-04-01$174.18$81.19RVU20B
2020-01-01$174.18$81.19RVU20A
2019-10-01$167.18$82.25RVU19D
2019-07-01$167.18$82.25RVU19C
2019-04-01$167.18$82.25RVU19B
2019-01-01$167.18$82.25RVU19A
2018-10-01$159.19$82.87RVU18D
2018-07-01$159.19$82.87RVU18C
2018-04-01$159.19$82.87RVU18B
2018-01-01$159.19$82.87RVU18AR1
2017-10-01$157.63$82.33RVU17D
2017-07-01$157.63$82.33RVU17C
2017-04-01$157.63$82.33RVU17B
2017-01-01$157.63$82.33RVU17A
2016-10-01$211.34$87.10RVU16D
2016-07-01$211.34$87.10RVU16C
2016-04-01$211.34$87.10RVU16B
2016-01-01$211.34$87.10RVU16A
2015-10-01$215.82$89.36RVU15D
2015-07-01$215.82$89.36RVU15C
2015-04-01$214.74$88.92RVU15B
2015-01-01$214.74$88.92RVU15A
2014-10-01$211.86$88.64RVU14D
2014-07-01$211.86$88.64RVU14C
2014-04-01$211.86$88.64RVU14B
2014-01-01$211.86$88.64RVU14A
2013-10-01$156.80$88.32RVU13D
2013-07-01$156.80$88.32RVU13C
2013-04-01$156.80$88.32RVU13B
2013-01-01$156.80$88.32RVU13AR

Price 43450 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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