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CPT code 43497: Esophageal myotomy, transoral approach2026 Medicare rate & RVUs

Reports endoscopic division of lower esophageal muscle, commonly to treat achalasia or selected spastic esophageal motility disorders.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.2K Medicare services in 2024

Medicare pays $718.45 for 43497 nationally in a facility.

Medicare rate · 43497

Esophageal myotomy, transoral approach

Office or facility?

Work RVUs
12.96
Total RVUs
21.51
Global days
090

National rate · 2026

$718.45

Facility setting, before claim adjustments.

See every locality for 43497 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 43497 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43497 covers

This procedure, often called POEM, uses a transoral endoscope to create a tunnel within the esophageal wall and divide muscle at the lower esophageal sphincter and distal esophagus. It is performed for achalasia and selected spastic motility disorders. A surgeon or advanced therapeutic endoscopist typically performs it in a hospital operating room under general anesthesia; the procedure includes endoscopic access, the myotomy, and closure of the mucosal entry.

Report 43497 when the operative record supports a transoral endoscopic myotomy, rather than esophageal dilation or an open myotomy. Documentation should identify the approach and the muscle treated. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery 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 43497 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43497 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$664.18
AlaskaUnavailable$922.55
ArizonaUnavailable$702.81
ArkansasUnavailable$657.51
Atlanta, GAUnavailable$735.44
Austin, TXUnavailable$725.54
Bakersfield, CAUnavailable$724.81
Baltimore area, MDUnavailable$756.09
Beaumont, TXUnavailable$693.89
Brazoria, TXUnavailable$706.66

43497 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
43497 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43497 rate is calculated

Each of 43497’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 · 43497

RVUs × geographic indexes × conversion factor

Office or facility?

Work12.96

12.96 RVUs× 1.000 GPCI

Practice expense6.75

6.75 RVUs× 1.000 GPCI

Malpractice1.80

1.80 RVUs× 1.000 GPCI

Adjusted RVUs

21.5100

Conversion factor

$33.4009

Medicare rate

$718.45

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 43497

43497 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43497

Esophageal myotomy, transoral approach

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures3Endoscopy family rules apply.
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.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 43497

Esophageal myotomy, transoral approach

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43497 without 51 · national facility

$718.45

Esophageal myotomy, transoral approach

43497-51 · Second procedure: 50%

$359.23

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

43497 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43497

    Esophageal myotomy, transoral approach12.96 wRVU

    Not priced

  • 43249

    Esophageal dilation, balloon under 30 mm2.6 wRVU

    $1,180.39

  • 43450

    Esophageal dilation, unguided sound or bougie1.25 wRVU

    $212.10

  • 43453

    Esophageal dilation, balloon with fluoroscopy1.37 wRVU

    $831.68

How to choose

43249Esophageal dilationBalloon under 30 mm
Use for endoscopic balloon dilation of the esophagus, not for cutting the lower esophageal muscle through a transoral tunnel.
43450Esophageal dilationUnguided sound or bougie
This code describes esophageal dilation by sound or bougie; 43497 describes a transoral endoscopic myotomy.
43453Esophageal dilationBalloon with fluoroscopy
This code describes esophageal dilation over a guide wire. Choose 43497 when the documented procedure divides lower esophageal muscle.

Codes related to 43497

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

Codes related to 43497
CodeHow it relatesNational office range
Used instead
43249Esophageal dilation, balloon under 30 mmEndoscopic balloon dilation of the esophagus can be an alternative treatment for achalasia.$1,022.75–$1,664.21
43450Esophageal dilation, unguided sound or bougieEsophageal dilation is a different treatment approach from transoral muscle division.$186.35–$287.44
43453Esophageal dilation, balloon with fluoroscopyGuidewire-assisted esophageal dilation is distinct from a transoral myotomy.$718.80–$1,178.65

43497 billing questions

When should 43497 be chosen over an esophageal dilation code?

Use 43497 when the provider performs a transoral endoscopic myotomy by cutting lower esophageal muscle. Dilation enlarges the passage without performing that myotomy.

How does 43497 differ from 43450 and 43453?

43497 describes a transoral myotomy. 43450 and 43453 describe esophageal dilation; 43453 is performed over a guide wire.

Can a related endoscopy be reported in the same session?

When related endoscopies are performed together, CMS endoscopy family pricing applies. The operative documentation should support each reported service.

Does modifier 50 apply to 43497?

No. CMS identifies bilateral adjustment as inappropriate for this code.

Can an assistant or co-surgeon be paid for 43497?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

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 43497PPRRVU2026_Oct_nonQPP.csv, line 5,254 (RVU26D)

Open CMS sourceHow we calculate rates

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