Billing code 43249: Esophageal dilationMedicare rate & RVUs
Reports upper endoscopy with balloon dilation of an esophageal narrowing using a balloon diameter under 30 mm, commonly to relieve dysphagia.
Medicare pays $1,180.39 for 43249 nationally in the office and $136.28 in a hospital or facility. Local office rates run $1,022.75–$1,664.21.
Medicare rate · 43249
Esophageal dilation
Swap in your local Medicare rate.
- Work RVUs
- 2.6
- Total RVUs
- 35.34
- Global days
- 000
National rate · 2026
$1,180.39
Office setting, before claim adjustments.
See every locality for 43249 → · 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
What 43249 covers
A gastroenterologist or other endoscopist advances an upper endoscope through the mouth to the esophagus and expands a balloon across a narrowed area. Common indications include dysphagia from a benign esophageal stricture or ring. The code is for dilation of the esophagus with a balloon under 30 mm; it is not the code for dilation of a gastric outlet. The service is commonly performed in an ambulatory endoscopy center or hospital outpatient department.
Select the code based on the site and dilation technique, and document the esophageal narrowing, balloon method, and maximum balloon diameter. Report the endoscopic procedure once for the session, not once per inflation. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. Endoscopy-family pricing applies when related endoscopies are performed together. Modifier 50 is inappropriate; assistant-at-surgery services are statutorily nonpayable, and co-surgeon and team-surgery billing 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 43249 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$1022.75 to $1664.21
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $1,040.60 | $127.00 |
| Alaska* | $1,289.74 | $177.76 |
| Arizona | $1,145.36 | $133.61 |
| Arkansas | $1,022.75 | $125.86 |
| Atlanta | $1,200.00 | $139.18 |
| Austin | $1,242.26 | $137.59 |
| Bakersfield | $1,282.14 | $137.79 |
| Baltimore/Surr. Cntys | $1,263.25 | $142.92 |
| Beaumont | $1,082.16 | $132.02 |
| Brazoria | $1,169.13 | $134.41 |
| Chicago | $1,199.39 | $150.06 |
| Chico | $1,281.23 | $136.89 |
| Colorado | $1,248.58 | $137.65 |
| Connecticut | $1,267.66 | $143.15 |
| Dallas | $1,175.41 | $135.48 |
| Dc + Md/Va Suburbs | $1,379.08 | $149.11 |
| Delaware | $1,166.81 | $135.22 |
| Detroit | $1,149.34 | $141.77 |
| East St. Louis | $1,103.87 | $143.28 |
| El Centro | $1,281.28 | $136.94 |
| Fort Lauderdale | $1,202.57 | $144.88 |
| Fort Worth | $1,164.71 | $135.21 |
| Fresno | $1,281.23 | $136.89 |
| Galveston | $1,171.77 | $134.97 |
| Hanford-Corcoran | $1,281.23 | $136.89 |
| Hawaii, Guam | $1,324.61 | $137.46 |
| Houston | $1,177.27 | $140.46 |
| Idaho | $1,088.43 | $127.84 |
| Indiana | $1,096.14 | $128.25 |
| Iowa | $1,082.25 | $126.88 |
| Kansas | $1,071.40 | $127.52 |
| Kentucky | $1,059.26 | $131.05 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $1,378.87 | $143.68 |
| Madera | $1,281.23 | $136.89 |
| Manhattan | $1,367.35 | $154.09 |
| Merced | $1,281.23 | $136.89 |
| Metropolitan Boston | $1,393.05 | $146.38 |
| Metropolitan Kansas City | $1,114.06 | $133.64 |
| Metropolitan Philadelphia | $1,228.31 | $141.39 |
| Metropolitan St. Louis | $1,128.40 | $134.40 |
| Miami | $1,240.13 | $153.21 |
| Minnesota | $1,204.76 | $130.36 |
| Mississippi | $1,027.16 | $128.18 |
| Modesto | $1,281.23 | $136.89 |
| Montana** | $1,180.37 | $136.26 |
| Napa | $1,525.49 | $149.35 |
| Nebraska | $1,090.72 | $127.01 |
| Nevada** | $1,179.80 | $134.64 |
| New Hampshire | $1,223.56 | $136.64 |
| New Mexico | $1,092.47 | $135.02 |
| New Orleans | $1,117.82 | $135.31 |
| North Carolina | $1,104.17 | $130.02 |
| North Dakota** | $1,174.44 | $130.32 |
| Northern Nj | $1,359.90 | $148.73 |
| Nyc Suburbs/Long Island | $1,399.32 | $157.87 |
| Ohio | $1,086.20 | $132.93 |
| Oklahoma | $1,062.22 | $129.82 |
| Oxnard-Thousand Oaks-Ventura | $1,376.24 | $142.10 |
| Portland | $1,299.48 | $139.47 |
| Poughkpsie/N Nyc Suburbs | $1,289.33 | $146.03 |
| Puerto Rico | $1,192.16 | $136.56 |
| Queens | $1,387.58 | $153.44 |
| Redding | $1,281.23 | $136.89 |
| Rest Of California | $1,281.23 | $136.89 |
| Rest Of Florida | $1,137.75 | $139.58 |
| Rest Of Georgia | $1,065.29 | $133.94 |
| Rest Of Illinois | $1,091.76 | $138.49 |
| Rest Of Louisiana | $1,055.36 | $131.32 |
| Rest Of Maine | $1,089.92 | $129.33 |
| Rest Of Maryland | $1,193.44 | $136.80 |
| Rest Of Massachusetts | $1,237.17 | $137.72 |
| Rest Of Michigan | $1,087.41 | $134.14 |
| Rest Of Missouri | $1,030.60 | $130.58 |
| Rest Of New Jersey | $1,284.52 | $144.35 |
| Rest Of New York | $1,123.24 | $131.33 |
| Rest Of Oregon | $1,173.08 | $133.14 |
| Rest Of Pennsylvania | $1,090.99 | $132.49 |
| Rest Of Texas | $1,124.16 | $133.29 |
| Rest Of Washington | $1,236.55 | $137.10 |
| Rhode Island | $1,216.71 | $138.14 |
| Riverside-San Bernardino-Ontario | $1,284.50 | $140.15 |
| Sacramento-Roseville-Folsom | $1,355.48 | $141.18 |
| Salinas | $1,350.71 | $140.59 |
| San Diego-Chula Vista-Carlsbad | $1,390.77 | $142.02 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $1,627.46 | $155.26 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $1,627.12 | $154.92 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $1,664.21 | $158.60 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $1,662.82 | $157.21 |
| San Luis Obispo-Paso Robles | $1,327.82 | $138.58 |
| Santa Cruz-Watsonville | $1,410.52 | $141.92 |
| Santa Maria-Santa Barbara | $1,358.04 | $140.60 |
| Santa Rosa-Petaluma | $1,425.39 | $143.22 |
| Seattle (King Cnty) | $1,428.86 | $147.73 |
| South Carolina | $1,096.54 | $131.78 |
| South Dakota** | $1,173.73 | $129.62 |
| Southern Maine | $1,166.94 | $132.22 |
| Stockton | $1,281.23 | $136.89 |
| Suburban Chicago | $1,217.99 | $145.68 |
| Tennessee | $1,077.15 | $128.05 |
| Utah | $1,114.35 | $132.89 |
| Vallejo | $1,525.00 | $148.86 |
| Vermont | $1,164.60 | $130.93 |
| Virgin Islands | $1,192.16 | $136.56 |
| Virginia | $1,159.02 | $132.66 |
| Visalia | $1,281.23 | $136.89 |
| West Virginia | $1,042.76 | $135.43 |
| Wisconsin | $1,127.95 | $127.69 |
| Wyoming** | $1,177.78 | $133.67 |
| Yuba City | $1,281.23 | $136.89 |
43249 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.
$1,022.75
$1,472.72
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,289.74 | 1 |
| AL | $1,040.60 | 1 |
| AR | $1,022.75 | 1 |
| AZ | $1,145.36 | 1 |
| CA | $1,281.23–$1,664.21 | 29 |
| CO | $1,248.58 | 1 |
| CT | $1,267.66 | 1 |
| DC | $1,379.08 | 1 |
| DE | $1,166.81 | 1 |
| FL | $1,137.75–$1,240.13 | 3 |
| GA | $1,065.29–$1,200.00 | 2 |
| GU | $1,324.61 | 1 |
| HI | $1,324.61 | 1 |
| IA | $1,082.25 | 1 |
| ID | $1,088.43 | 1 |
| IL | $1,091.76–$1,217.99 | 4 |
| IN | $1,096.14 | 1 |
| KS | $1,071.40 | 1 |
| KY | $1,059.26 | 1 |
| LA | $1,055.36–$1,117.82 | 2 |
| MA | $1,237.17–$1,393.05 | 2 |
| MD | $1,193.44–$1,379.08 | 3 |
| ME | $1,089.92–$1,166.94 | 2 |
| MI | $1,087.41–$1,149.34 | 2 |
| MN | $1,204.76 | 1 |
| MO | $1,030.60–$1,128.40 | 3 |
| MS | $1,027.16 | 1 |
| MT | $1,180.37 | 1 |
| NC | $1,104.17 | 1 |
| ND | $1,174.44 | 1 |
| NE | $1,090.72 | 1 |
| NH | $1,223.56 | 1 |
| NJ | $1,284.52–$1,359.90 | 2 |
| NM | $1,092.47 | 1 |
| NV | $1,179.80 | 1 |
| NY | $1,123.24–$1,399.32 | 5 |
| OH | $1,086.20 | 1 |
| OK | $1,062.22 | 1 |
| OR | $1,173.08–$1,299.48 | 2 |
| PA | $1,090.99–$1,228.31 | 2 |
| PR | $1,192.16 | 1 |
| RI | $1,216.71 | 1 |
| SC | $1,096.54 | 1 |
| SD | $1,173.73 | 1 |
| TN | $1,077.15 | 1 |
| TX | $1,082.16–$1,242.26 | 8 |
| UT | $1,114.35 | 1 |
| VA | $1,159.02–$1,379.08 | 2 |
| VI | $1,192.16 | 1 |
| VT | $1,164.60 | 1 |
| WA | $1,236.55–$1,428.86 | 2 |
| WI | $1,127.95 | 1 |
| WV | $1,042.76 | 1 |
| WY | $1,177.78 | 1 |
How the 43249 rate is calculated
Each of 43249’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 · 43249
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.60Practice expense 32.44Malpractice 0.30
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43249
The CMS indicators that decide how 43249 is paid alongside other services.
CMS payment indicators · 43249
Esophageal dilation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| 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) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43249 without 51 · national office
$1,180.39
Esophageal dilation
43249-51 · Second procedure: 50%
$590.20
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%).
43249 compared with similar codes
Compare codes
43249 vs 43248 vs 43245 vs 43239: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43248Esophageal dilation
- Choose 43249 for esophageal balloon dilation under 30 mm. Choose 43248 when the esophagus is dilated over a guide wire.
- 43245EGD dilation
- 43245 is for dilation of the gastric outlet. This code is for balloon dilation of an esophageal narrowing.
- 43239EGD with biopsy
- 43239 reports upper endoscopy with biopsy, not esophageal balloon dilation. It may be reported for a separately performed biopsy during the same session, subject to endoscopy-family pricing.
43249 billing questions
How does this differ from 43248?
43249 is for balloon dilation of the esophagus with a balloon under 30 mm. Use 43248 when dilation is performed over a guide wire.
Can this code be used for gastric outlet dilation?
No. This code is for dilation in the esophagus; 43245 describes dilation of the gastric outlet.
How many units should be reported if the balloon is inflated more than once?
Report the endoscopic dilation once for the session, not a separate unit for each inflation.
What documentation supports the code?
Document the esophageal narrowing, the balloon dilation technique, and the maximum balloon diameter used, which must be under 30 mm for this code.
Can modifier 50 be used, or can an assistant or co-surgeon be reported?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for it, and co-surgeon and team-surgery billing are not permitted.
Is same-day care included in the payment?
Yes. The 0-day global period includes same-day preoperative and postoperative care; related endoscopies performed together are subject to endoscopy-family pricing.
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
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