CPT code 43453: Esophageal dilation, balloon with fluoroscopy2026 Medicare rate & RVUs in California
Reports balloon dilation of an esophageal narrowing when the catheter is positioned and the procedure is performed with fluoroscopic guidance.
Medicare pays $904.54–$1,178.65 for 43453 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 43453 covers
This service enlarges a narrowed segment of the esophagus by inflating a balloon catheter under fluoroscopic guidance. It may be used for conditions such as a benign stricture, ring, or web that limits passage through the esophagus. A gastroenterologist or interventional radiologist typically performs the dilation in a hospital or outpatient procedure setting. The fluoroscopic balloon approach distinguishes this service from dilation performed through an endoscope or with an unguided bougie.
Report the service when the esophageal dilation uses a balloon catheter with fluoroscopic guidance. Documentation should identify the narrowing and its location, the balloon-catheter technique, and the fluoroscopic guidance used. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, 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.
Where 43453 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
$904.54 to $1178.65
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $905.07 | $78.48 |
| Chico, CA | $904.54 | $77.95 |
| El Centro, CA | $904.57 | $77.98 |
| Fresno, CA | $904.54 | $77.95 |
| Hanford, CA | $904.54 | $77.95 |
| Los Angeles, CA | $974.26 | $82.05 |
| Madera, CA | $904.54 | $77.95 |
| Marin County, CA | $1,152.54 | $89.13 |
| Merced, CA | $904.54 | $77.95 |
| Modesto, CA | $904.54 | $77.95 |
| Napa, CA | $1,079.62 | $85.59 |
| Oxnard, CA | $972.64 | $81.19 |
| Redding, CA | $904.54 | $77.95 |
| Rest of California | $904.54 | $77.95 |
| Riverside, CA | $906.49 | $79.90 |
| Sacramento, CA | $957.67 | $80.54 |
| Salinas, CA | $954.32 | $80.21 |
| San Benito County, CA | $1,178.65 | $91.10 |
| San Diego, CA | $983.16 | $81.15 |
| San Francisco, CA | $1,152.34 | $88.92 |
| San Luis Obispo, CA | $938.08 | $79.05 |
| Santa Clara County, CA | $1,177.81 | $90.27 |
| Santa Cruz, CA | $997.53 | $81.19 |
| Santa Maria, CA | $959.64 | $80.25 |
| Santa Rosa, CA | $1,008.09 | $81.94 |
| Stockton, CA | $904.54 | $77.95 |
| Vallejo, CA | $1,079.32 | $85.30 |
| Visalia, CA | $904.54 | $77.95 |
| Yuba City, CA | $904.54 | $77.95 |
How the 43453 rate is calculated
Each of 43453’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 · 43453
RVUs × geographic indexes × conversion factor
Work1.37
1.37 RVUs× 1.000 GPCI
Practice expense23.35
23.35 RVUs× 1.000 GPCI
Malpractice0.18
0.18 RVUs× 1.000 GPCI
Adjusted RVUs
24.9000
Conversion factor
$33.4009
Medicare rate
$831.68
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43453
The CMS indicators that decide how 43453 is paid alongside other services.
CMS payment indicators · 43453
Esophageal dilation, balloon with fluoroscopy
| 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
43453 without 51 · national office
$831.68
Esophageal dilation, balloon with fluoroscopy
43453-51 · Second procedure: 50%
$415.84
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%).
43453 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43450Esophageal dilationUnguided sound or bougie
- Choose 43453 for fluoroscopic balloon-catheter dilation; choose 43450 for dilation with an unguided sound or bougie.
- 43249Esophageal dilationBalloon under 30 mm
- 43249 describes endoscopic balloon dilation with a balloon under 30 mm. This code describes fluoroscopic balloon-catheter dilation.
- 43233Esophageal dilationBalloon 30 mm or larger
- 43233 describes endoscopic balloon dilation with a balloon 30 mm or larger; 43453 identifies the fluoroscopic balloon-catheter approach.
43453 billing questions
How does this differ from 43450?
43453 is for balloon-catheter dilation under fluoroscopic guidance. 43450 describes dilation with an unguided sound or bougie.
When would an endoscopic dilation code be more appropriate?
Use an endoscopic dilation code when dilation is performed through an endoscope. For example, 43249 and 43233 distinguish endoscopic balloon dilation by balloon diameter.
Is same-day postoperative care separately reported?
Same-day preoperative and postoperative care is included in this service's 0-day global period.
Can modifier 50 be used for dilation on both sides?
No. The code's descriptor or anatomy makes bilateral adjustment inappropriate.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the session are subject to the standard multiple-procedure reduction.
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
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