CPT code 43499: Esophageal procedure, unlisted2026 Medicare rate & RVUs in Georgia
Reports an esophageal procedure for which no specific CPT code describes the service; Medicare payment is set by the contractor.
CMS doesn’t publish an office rate for 43499 in Georgia.
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 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 in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta, GA | Unavailable | Unavailable |
| Rest of Georgia | Unavailable | Unavailable |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | YYY | The Medicare contractor sets the global period. |
| 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) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| Professional/technical | 0 | Physician 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%).
43499 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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