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Billing code 43195: Esophageal dilationMedicare rate & RVUs

Reports transoral rigid esophageal examination with balloon dilation to treat a narrowing, such as a stricture, during the same procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities700 Medicare services in 2024

Medicare pays $159.32 for 43195 nationally in a facility.

Medicare rate · 43195

Esophageal dilation

Work RVUs
2.99
Total RVUs
4.77
Global days
000

National rate · 2026

$159.32

Facility setting, before claim adjustments.

See every locality for 43195 →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.

On this page 10 sections
  1. Medicare rate
  2. What 43195 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 43195 covers

The physician passes a rigid scope through the mouth to reach the esophagus and uses an inflatable balloon to widen a narrowed segment. This approach may be used for an esophageal stricture or other stenosis. Otolaryngologists and thoracic surgeons commonly perform rigid esophagoscopy in an operating room or hospital procedure setting; the documented service should show that balloon dilation was performed, not just inspection.

Choose this code when the dilation is performed with a balloon through a rigid transoral scope. Record the treated site and findings, the dilation performed, and relevant balloon details. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery reporting 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 43195 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

43195 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$147.45
Alaska*Unavailable$205.74
ArizonaUnavailable$155.86
ArkansasUnavailable$146.00
AtlantaUnavailable$163.23
AustinUnavailable$160.50
BakersfieldUnavailable$159.93
Baltimore/Surr. CntysUnavailable$167.62
BeaumontUnavailable$154.24
BrazoriaUnavailable$156.56

43195 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
43195 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 43195 rate is calculated

Each of 43195’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 · 43195

RVUs × geographic indexes × conversion factor

Work2.99

2.99 RVUs× 1.000 GPCI

Practice expense1.35

1.35 RVUs× 1.000 GPCI

Malpractice0.43

0.43 RVUs× 1.000 GPCI

Adjusted RVUs

4.7700

Conversion factor

$33.4009

Medicare rate

$159.32

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

Payment rules and modifiers for 43195

The CMS indicators that decide how 43195 is paid alongside other services.

CMS payment indicators · 43195

Esophageal dilation

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43195 without 51 · national facility

$159.32

Esophageal dilation

43195-51 · Second procedure: 50%

$79.66

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

43195 compared with similar codes

Compare codes · National

5 codes, side by side

  • 43195

    Esophageal dilation2.99 wRVU

    Not priced

  • 43196

    Esophageal dilation3.23 wRVU

    Not priced

  • 43249

    Esophageal dilation2.6 wRVU

    $1,180.39

  • 43191

    Esophagoscopy2.43 wRVU

    Not priced

  • 43193

    Esophagoscopy2.72 wRVU

    Not priced

How to choose

43196Esophageal dilation
Both describe rigid transoral esophageal dilation, but 43196 uses a guide wire to direct dilation rather than a balloon.
43249Esophageal dilation
This is the flexible endoscopic balloon-dilation option; 43195 uses a rigid transoral scope.
43191Esophagoscopy
43191 is for diagnostic rigid esophagoscopy. Choose 43195 when the service includes balloon dilation of an esophageal narrowing.
43193Esophagoscopy
43193 reports biopsy during rigid esophagoscopy; 43195 reports balloon dilation, not tissue sampling.

Codes related to 43195

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

Codes related to 43195
CodeHow it relatesNational office range
Used instead
43196Esophageal dilationRigid-scope esophageal dilation using an inserted guide wire rather than a balloon.No office rate
43249Esophageal dilationFlexible endoscopic balloon dilation for an esophageal narrowing.$1,022.75–$1,664.21
Same family
43191EsophagoscopyRigid transoral esophagoscopy for diagnostic examination without the balloon dilation service.No office rate
43193EsophagoscopyRigid transoral esophagoscopy with biopsy rather than balloon dilation.No office rate
43194Foreign body removalRigid transoral esophagoscopy for foreign-body removal.No office rate

43195 billing questions

When should this code be chosen instead of 43196?

Use 43195 for balloon dilation through a rigid transoral scope. Code 43196 describes dilation performed over an inserted guide wire.

Can a diagnostic esophagoscopy be separately reported with the dilation?

When related endoscopies are performed together, CMS endoscopy family pricing applies. The documentation should identify the actual procedures performed; do not assume a separate diagnostic endoscopy receives independent payment.

What documentation supports reporting this service?

Document the rigid transoral approach, the esophageal narrowing and its location, and that balloon dilation was performed. Include pertinent details of the dilation, such as the balloon used.

Is modifier 50 appropriate if the esophagus is treated on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery reporting 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 43195PPRRVU2026_Oct_nonQPP.csv, line 5,136 (RVU26D)

Open CMS sourceHow we calculate rates

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