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

Reports an esophageal procedure for which no specific CPT code describes the service; Medicare payment is set by the contractor.

CMS RVU26DEffective Oct 1, 2026One payment locality1.6K Medicare services in 2024

CMS doesn’t publish a rate for 43499 in Colorado.

Contractor-pricedOffice (non-facility)
Contractor-pricedHospital or facility

Check a contract rate as a % of Medicare · 43499 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 43499 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Colorado
  2. What 43499 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 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.

How Colorado compares for 43499

43499 in Colorado vs other payment areas
  1. Colorado · this pageUnavailable
  2. Los Angeles, CA · CaliforniaUnavailable
  3. Washington, DC area · District of ColumbiaUnavailable
  4. Miami, FL · FloridaUnavailable
  5. Chicago, IL · IllinoisUnavailable
  6. Manhattan, NY · New YorkUnavailable
  7. Alaska · AlaskaUnavailable

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

Every other payment area

43499 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama——
ArkansasArkansas——
ArizonaArizona——
Bakersfield, CACalifornia——
Chico, CACalifornia——
El Centro, CACalifornia——
Fresno, CACalifornia——
Hanford, CACalifornia——

43499 rates by state

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

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.

View every state and territory as a table
43499 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

See 43499 in every payment locality

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.

How the rate is built · 43499

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

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

Payment rules and modifiers for 43499

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

CMS payment indicators · 43499

Esophageal procedure, unlisted

RuleCMS valueWhat it means
Global periodYYYThe Medicare contractor sets the global period.
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)1Permitted with supporting documentation.
Team surgery (66)1Permitted with supporting documentation.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43499 without 51 · national facility

$0.00

Esophageal procedure, unlisted

43499-51 · Second procedure: 50%

$0.00

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

How 43499 has changed in Colorado

43499 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

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
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Contractor-pricedContractor-pricedRVU26D
2026-07-01Contractor-pricedContractor-pricedRVU26C
2026-04-01Contractor-pricedContractor-pricedRVU26B
2026-01-01Contractor-pricedContractor-pricedRVU26A
2025-10-01Contractor-pricedContractor-pricedRVU25D
2025-07-01Contractor-pricedContractor-pricedRVU25C
2025-04-01Contractor-pricedContractor-pricedRVU25B
2025-01-01Contractor-pricedContractor-pricedRVU25A
2024-10-01Contractor-pricedContractor-pricedRVU24D
2024-07-01Contractor-pricedContractor-pricedRVU24C
2024-04-01Contractor-pricedContractor-pricedRVU24B
2024-03-09Contractor-pricedContractor-pricedRVU24AR
2024-01-01Contractor-pricedContractor-pricedRVU24A
2023-10-01Contractor-pricedContractor-pricedRVU23D
2023-07-01Contractor-pricedContractor-pricedRVU23C
2023-04-01Contractor-pricedContractor-pricedRVU23B
2023-01-01Contractor-pricedContractor-pricedRVU23A
2022-10-01Contractor-pricedContractor-pricedRVU22D
2022-07-01Contractor-pricedContractor-pricedRVU22C
2022-04-01Contractor-pricedContractor-pricedRVU22B
2022-01-01Contractor-pricedContractor-pricedRVU22A
2021-10-01Contractor-pricedContractor-pricedRVU21D
2021-07-01Contractor-pricedContractor-pricedRVU21C
2021-04-01Contractor-pricedContractor-pricedRVU21B
2021-01-01Contractor-pricedContractor-pricedRVU21A
2020-10-01Contractor-pricedContractor-pricedRVU20D
2020-07-01Contractor-pricedContractor-pricedRVU20C
2020-04-01Contractor-pricedContractor-pricedRVU20B
2020-01-01Contractor-pricedContractor-pricedRVU20A
2019-10-01Contractor-pricedContractor-pricedRVU19D
2019-07-01Contractor-pricedContractor-pricedRVU19C
2019-04-01Contractor-pricedContractor-pricedRVU19B
2019-01-01Contractor-pricedContractor-pricedRVU19A
2018-10-01Contractor-pricedContractor-pricedRVU18D
2018-07-01Contractor-pricedContractor-pricedRVU18C
2018-04-01Contractor-pricedContractor-pricedRVU18B
2018-01-01Contractor-pricedContractor-pricedRVU18AR1
2017-10-01Contractor-pricedContractor-pricedRVU17D
2017-07-01Contractor-pricedContractor-pricedRVU17C
2017-04-01Contractor-pricedContractor-pricedRVU17B
2017-01-01Contractor-pricedContractor-pricedRVU17A
2016-10-01Contractor-pricedContractor-pricedRVU16D
2016-07-01Contractor-pricedContractor-pricedRVU16C
2016-04-01Contractor-pricedContractor-pricedRVU16B
2016-01-01Contractor-pricedContractor-pricedRVU16A
2015-10-01Contractor-pricedContractor-pricedRVU15D
2015-07-01Contractor-pricedContractor-pricedRVU15C
2015-04-01Contractor-pricedContractor-pricedRVU15B
2015-01-01Contractor-pricedContractor-pricedRVU15A
2014-10-01Contractor-pricedContractor-pricedRVU14D
2014-07-01Contractor-pricedContractor-pricedRVU14C
2014-04-01Contractor-pricedContractor-pricedRVU14B
2014-01-01Contractor-pricedContractor-pricedRVU14A
2013-10-01Contractor-pricedContractor-pricedRVU13D
2013-07-01Contractor-pricedContractor-pricedRVU13C
2013-04-01Contractor-pricedContractor-pricedRVU13B
2013-01-01Contractor-pricedContractor-pricedRVU13AR

Price 43499 for an earlier date of service

Where the Colorado rate applies

Colorado is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in Colorado. Some span more than one payment area; confirm with the service ZIP.

  • Acres Green
  • Aetna Estates
  • Aguilar
  • Air Force Academy
  • Akron
  • Alamosa
  • Alamosa East
  • Allenspark

Browse all communities in Colorado

43499 billing questions

When should 43499 be used instead of a specific esophageal procedure code?

Use 43499 for an esophageal procedure that does not have a more specific CPT code. Listed codes for procedures such as dilation or transoral lower esophageal myotomy apply when the procedure performed matches.

How does Medicare price 43499?

Medicare physician fee schedule status C means there is no national payment; the Medicare Administrative Contractor sets payment for each claim.

Who sets the global period for 43499?

The Medicare contractor sets the global period.

How is 43499 treated when multiple procedures are performed in the same session?

The highest-valued procedure is paid in full and the others at 50% under the stated Medicare multiple procedure rule.

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

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