CPT code 43499: Esophageal procedure, unlisted2026 Medicare rate & RVUs

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

What 43499 covers

Code 43499 identifies an unlisted procedure involving the esophagus: the procedure performed does not have a more specific CPT code. It is selected based on the service actually performed, rather than as a substitute for a listed esophageal procedure that describes that service. Nearby listed codes address procedures such as esophageal vein ligation, repair, dilation, and transoral lower esophageal myotomy; those codes apply when their described procedure matches the work. The code is reported for the unlisted esophageal service.

Medicare assigns physician fee schedule status C, carrier priced. CMS publishes no national payment; the Medicare Administrative Contractor sets payment for each claim. The contractor also sets the global period. For multiple procedures performed in the same session, the highest-valued procedure is paid in full and the others at 50% under the stated multiple procedure rule. Report the code only for the unlisted esophageal service; select a specific esophageal code when it describes the procedure.

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 43499 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

43499 rates by state

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

How the 43499 rate is calculated

Each of 43499’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.

Payment rules and modifiers for 43499

The CMS indicators that decide how 43499 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

43499 compared with similar codes

How to choose

43450Esophageal dilationUnguided sound or bougie

43450 is for esophageal dilation. Use 43499 when the procedure is not described by a specific code such as 43450.

43410Esophageal repairCervical approach

43410 is for the esophageal wound-repair procedure described by that code. Use 43499 for a different esophageal procedure without a specific CPT code.

43497Esophageal myotomyTransoral approach

43497 identifies a specific transoral lower esophageal myotomy. Use 43499 only when that specific procedure does not describe the work performed.

Codes related to 43499

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

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

Open CMS sourceHow we calculate rates