$1,166.81
Use for endoscopic balloon dilation of the esophagus, not for cutting the lower esophageal muscle through a transoral tunnel.
On this page
CMS RVU26D · Effective 2026-10-01
43497 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$711.84
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Gastrointestinal surgery
About 43497: Transoral lower esophageal myotomy
Reports endoscopic division of lower esophageal muscle, commonly to treat achalasia or selected spastic esophageal motility disorders.
This procedure, often called POEM, uses a transoral endoscope to create a tunnel within the esophageal wall and divide muscle at the lower esophageal sphincter and distal esophagus. It is performed for achalasia and selected spastic motility disorders. A surgeon or advanced therapeutic endoscopist typically performs it in a hospital operating room under general anesthesia; the procedure includes endoscopic access, the myotomy, and closure of the mucosal entry.
Report 43497 when the operative record supports a transoral endoscopic myotomy, rather than esophageal dilation or an open myotomy. Documentation should identify the approach and the muscle treated. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 43497
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.96 · 60%
- Practice expense (office) RVU6.75 · 31%
- Malpractice RVU1.80 · 8%
1.2K
Medicare services in 2024 · #2822 by national volume
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.
43497 compared with similar codes
Office rates for Delaware, from the same CMS release.
$209.81
This code describes esophageal dilation by sound or bougie; 43497 describes a transoral endoscopic myotomy.
$821.95
This code describes esophageal dilation over a guide wire. Choose 43497 when the documented procedure divides lower esophageal muscle.
The same code, a different location
How does Delaware compare?
43497 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Alabama
Alabama · 43497
Office
Unavailable
Facility
$664.18
No comparable office rate is available.
Arkansas
Arkansas · 43497
Office
Unavailable
Facility
$657.51
No comparable office rate is available.
Arizona
Arizona · 43497
Office
Unavailable
Facility
$702.81
No comparable office rate is available.
Bakersfield
California · 43497
Office
Unavailable
Facility
$724.81
No comparable office rate is available.
Chico
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
El Centro
California · 43497
Office
Unavailable
Facility
$719.86
No comparable office rate is available.
Fresno
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Hanford-Corcoran
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Madera
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Merced
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Modesto
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Napa
California · 43497
Office
Unavailable
Facility
$787.84
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 43497
Office
Unavailable
Facility
$748.94
No comparable office rate is available.
Redding
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Rest Of California
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 43497
Office
Unavailable
Facility
$739.05
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 43497
Office
Unavailable
Facility
$742.89
No comparable office rate is available.
Salinas
California · 43497
Office
Unavailable
Facility
$739.82
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 43497
Office
Unavailable
Facility
$748.09
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 43497
Office
Unavailable
Facility
$819.49
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 43497
Office
Unavailable
Facility
$817.44
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 43497
Office
Unavailable
Facility
$837.82
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 43497
Office
Unavailable
Facility
$829.47
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 43497
Office
Unavailable
Facility
$729.25
No comparable office rate is available.
Santa Cruz-Watsonville
California · 43497
Office
Unavailable
Facility
$748.12
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 43497
Office
Unavailable
Facility
$740.10
No comparable office rate is available.
Santa Rosa-Petaluma
California · 43497
Office
Unavailable
Facility
$754.95
No comparable office rate is available.
Stockton
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Vallejo
California · 43497
Office
Unavailable
Facility
$784.89
No comparable office rate is available.
Visalia
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Yuba City
California · 43497
Office
Unavailable
Facility
$719.56
No comparable office rate is available.
Colorado
Colorado · 43497
Office
Unavailable
Facility
$724.91
No comparable office rate is available.
Connecticut
Connecticut · 43497
Office
Unavailable
Facility
$757.10
No comparable office rate is available.
Fort Lauderdale
Florida · 43497
Office
Unavailable
Facility
$769.96
No comparable office rate is available.
Rest Of Florida
Florida · 43497
Office
Unavailable
Facility
$738.77
No comparable office rate is available.
Atlanta
Georgia · 43497
Office
Unavailable
Facility
$735.44
No comparable office rate is available.
Rest Of Georgia
Georgia · 43497
Office
Unavailable
Facility
$705.65
No comparable office rate is available.
Hawaii, Guam
Hawaii · 43497
Office
Unavailable
Facility
$724.03
No comparable office rate is available.
Iowa
Iowa · 43497
Office
Unavailable
Facility
$663.04
No comparable office rate is available.
Idaho
Idaho · 43497
Office
Unavailable
Facility
$668.73
No comparable office rate is available.
East St. Louis
Illinois · 43497
Office
Unavailable
Facility
$761.38
No comparable office rate is available.
Rest Of Illinois
Illinois · 43497
Office
Unavailable
Facility
$732.69
No comparable office rate is available.
Suburban Chicago
Illinois · 43497
Office
Unavailable
Facility
$773.98
No comparable office rate is available.
Indiana
Indiana · 43497
Office
Unavailable
Facility
$671.09
No comparable office rate is available.
Kansas
Kansas · 43497
Office
Unavailable
Facility
$666.99
No comparable office rate is available.
Kentucky
Kentucky · 43497
Office
Unavailable
Facility
$688.32
No comparable office rate is available.
New Orleans
Louisiana · 43497
Office
Unavailable
Facility
$713.33
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 43497
Office
Unavailable
Facility
$690.00
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 43497
Office
Unavailable
Facility
$773.33
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 43497
Office
Unavailable
Facility
$725.12
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 43497
Office
Unavailable
Facility
$756.09
No comparable office rate is available.
Rest Of Maryland
Maryland · 43497
Office
Unavailable
Facility
$720.56
No comparable office rate is available.
Rest Of Maine
Maine · 43497
Office
Unavailable
Facility
$677.69
No comparable office rate is available.
Southern Maine
Maine · 43497
Office
Unavailable
Facility
$694.24
No comparable office rate is available.
Detroit
Michigan · 43497
Office
Unavailable
Facility
$751.81
No comparable office rate is available.
Rest Of Michigan
Michigan · 43497
Office
Unavailable
Facility
$706.59
No comparable office rate is available.
Minnesota
Minnesota · 43497
Office
Unavailable
Facility
$682.67
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 43497
Office
Unavailable
Facility
$703.32
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 43497
Office
Unavailable
Facility
$707.75
No comparable office rate is available.
Rest Of Missouri
Missouri · 43497
Office
Unavailable
Facility
$685.78
No comparable office rate is available.
Mississippi
Mississippi · 43497
Office
Unavailable
Facility
$671.42
No comparable office rate is available.
Montana**
Montana · 43497
Office
Unavailable
Facility
$718.33
No comparable office rate is available.
North Carolina
North Carolina · 43497
Office
Unavailable
Facility
$681.64
No comparable office rate is available.
North Dakota**
North Dakota · 43497
Office
Unavailable
Facility
$682.74
No comparable office rate is available.
Nebraska
Nebraska · 43497
Office
Unavailable
Facility
$663.70
No comparable office rate is available.
New Hampshire
New Hampshire · 43497
Office
Unavailable
Facility
$720.18
No comparable office rate is available.
Northern Nj
New Jersey · 43497
Office
Unavailable
Facility
$785.89
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 43497
Office
Unavailable
Facility
$762.34
No comparable office rate is available.
New Mexico
New Mexico · 43497
Office
Unavailable
Facility
$711.82
No comparable office rate is available.
Nevada**
Nevada · 43497
Office
Unavailable
Facility
$708.64
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 43497
Office
Unavailable
Facility
$840.29
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 43497
Office
Unavailable
Facility
$771.98
No comparable office rate is available.
Queens
New York · 43497
Office
Unavailable
Facility
$813.76
No comparable office rate is available.
Rest Of New York
New York · 43497
Office
Unavailable
Facility
$689.32
No comparable office rate is available.
Ohio
Ohio · 43497
Office
Unavailable
Facility
$699.32
No comparable office rate is available.
Oklahoma
Oklahoma · 43497
Office
Unavailable
Facility
$680.92
No comparable office rate is available.
Portland
Oregon · 43497
Office
Unavailable
Facility
$735.01
No comparable office rate is available.
Rest Of Oregon
Oregon · 43497
Office
Unavailable
Facility
$699.70
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 43497
Office
Unavailable
Facility
$747.09
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 43497
Office
Unavailable
Facility
$696.66
No comparable office rate is available.
Puerto Rico
Puerto Rico · 43497
Office
Unavailable
Facility
$720.03
No comparable office rate is available.
Rhode Island
Rhode Island · 43497
Office
Unavailable
Facility
$727.62
No comparable office rate is available.
South Carolina
South Carolina · 43497
Office
Unavailable
Facility
$692.30
No comparable office rate is available.
South Dakota**
South Dakota · 43497
Office
Unavailable
Facility
$678.53
No comparable office rate is available.
Tennessee
Tennessee · 43497
Office
Unavailable
Facility
$670.10
No comparable office rate is available.
Austin
Texas · 43497
Office
Unavailable
Facility
$725.54
No comparable office rate is available.
Beaumont
Texas · 43497
Office
Unavailable
Facility
$693.89
No comparable office rate is available.
Brazoria
Texas · 43497
Office
Unavailable
Facility
$706.66
No comparable office rate is available.
Dallas
Texas · 43497
Office
Unavailable
Facility
$712.91
No comparable office rate is available.
Fort Worth
Texas · 43497
Office
Unavailable
Facility
$711.44
No comparable office rate is available.
Galveston
Texas · 43497
Office
Unavailable
Facility
$710.00
No comparable office rate is available.
Houston
Texas · 43497
Office
Unavailable
Facility
$742.94
No comparable office rate is available.
Rest Of Texas
Texas · 43497
Office
Unavailable
Facility
$701.12
No comparable office rate is available.
Utah
Utah · 43497
Office
Unavailable
Facility
$698.79
No comparable office rate is available.
Virginia
Virginia · 43497
Office
Unavailable
Facility
$696.94
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 43497
Office
Unavailable
Facility
$720.03
No comparable office rate is available.
Vermont
Vermont · 43497
Office
Unavailable
Facility
$686.50
No comparable office rate is available.
Rest Of Washington
Washington · 43497
Office
Unavailable
Facility
$721.66
No comparable office rate is available.
Seattle (King Cnty)
Washington · 43497
Office
Unavailable
Facility
$780.27
No comparable office rate is available.
Wisconsin
Wisconsin · 43497
Office
Unavailable
Facility
$667.38
No comparable office rate is available.
West Virginia
West Virginia · 43497
Office
Unavailable
Facility
$714.83
No comparable office rate is available.
Wyoming**
Wyoming · 43497
Office
Unavailable
Facility
$702.82
No comparable office rate is available.
See how rates vary across the country
43497 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 43497 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$783.02
$711.84 × 110% = $783.02
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43497 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,254
- Code
- 43497
- Physician work
- 12.96
- Practice expense
- 6.75
- Malpractice
- 1.80
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.96 | × 1.005 | 13.0248 |
| Practice expense | 6.75 | × 0.988 | 6.6690 |
| Malpractice | 1.80 | × 0.899 | 1.6182 |
| Total RVUs | 21.3120 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$711.84
Open 43497 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.96 | 1.005 |
| Practice expense | 6.75 | 0.988 |
| Malpractice | 1.8 | 0.899 |
(12.96 × 1.005 + 6.75 × 0.988 + 1.8 × 0.899) × $33.4009 = $711.84
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
43497 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $711.84 | RVU26D |
| 2026-07-01 | Not available in this setting | $711.84 | RVU26C |
| 2026-04-01 | Not available in this setting | $711.84 | RVU26B |
| 2026-01-01 | Not available in this setting | $711.84 | RVU26A |
| 2025-10-01 | Not available in this setting | $760.99 | RVU25D |
| 2025-07-01 | Not available in this setting | $760.99 | RVU25C |
| 2025-04-01 | Not available in this setting | $760.99 | RVU25B |
| 2025-01-01 | Not available in this setting | $760.99 | RVU25A |
43497 billing questions
When should 43497 be chosen over an esophageal dilation code?
Use 43497 when the provider performs a transoral endoscopic myotomy by cutting lower esophageal muscle. Dilation enlarges the passage without performing that myotomy.
How does 43497 differ from 43450 and 43453?
43497 describes a transoral myotomy. 43450 and 43453 describe esophageal dilation; 43453 is performed over a guide wire.
Can a related endoscopy be reported in the same session?
When related endoscopies are performed together, CMS endoscopy family pricing applies. The operative documentation should support each reported service.
Does modifier 50 apply to 43497?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be paid for 43497?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,25143453,,Dilate esophagus,A,,1.37,23.35,,0.77,,0.18,24.90,2.32,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25243460,,Pressure treatment esophagus,A,,3.70,1.50,NA,1.50,,0.42,5.62,5.62,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25343496,,Free jejunum flap microvasc,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25443497,,Transorl lwr esophgl myotomy,A,,12.96,6.75,NA,6.75,,1.80,21.51,21.51,0,090,0.09,0.81,0.10,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,25543499,,Unlisted procedure esophagus,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25643500,,Surgical opening of stomach,A,,12.47,6.79,NA,6.79,,3.25,22.51,22.51,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25743501,,Surgical repair of stomach,A,,22.04,10.11,NA,10.11,,5.83,37.98,37.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503