FeeBase
Log inGet started
Menu
On this page

CMS RVU26D · Effective 2026-10-01

43248 in Merced

Office / nonfacility

$488.03

Base rate per service

Facility setting

$148.32

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 endoscopy

About 43248: Guidewire esophageal dilation during EGD

Report guidewire-assisted esophageal dilation during upper endoscopy when a dilator is advanced over a wire to treat an esophageal narrowing.

During upper endoscopy, the physician passes a guide wire through the narrowed esophagus and advances a dilator over it to widen the passage. Gastroenterologists and other physicians trained in endoscopy commonly perform this for symptomatic esophageal strictures, such as narrowing that causes difficulty swallowing, in hospital outpatient departments and ambulatory surgery centers.

Choose this code when the documented dilation is performed over a guide wire; record the esophageal site, the narrowing treated, and the wire-guided technique. A balloon dilation of the esophagus is represented by a different code. This service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate. CMS does not pay for an assistant at surgery, and co-surgeons and team surgery are not permitted for this service.

CMS billing rules for 43248

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU2.84 · 21%
  • Practice expense (office) RVU10.53 · 77%
  • Malpractice RVU0.34 · 2%

122.8K

Medicare services in 2024 · #506 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.

43248 compared with similar codes

Office rates for Merced, from the same CMS release.

43249

Esophageal dilation

Balloon under 30 mm

$1,281.23

Use 43248 for dilation over a guide wire; use 43249 when the esophagus is dilated with a balloon smaller than 30 mm.

43245

EGD dilation

Gastric outlet obstruction

$702.10

Code 43245 describes dilation of the gastric outlet, not dilation of an esophageal narrowing.

43241

Endoscopic tube placement

Intraluminal tube or catheter

No office rate

Code 43241 concerns placement of an intraluminal tube or catheter; it does not represent guidewire-assisted esophageal dilation.

The same code, a different location

How does Merced compare?

In Bakersfield, the office rate for 43248 is $489.05—$1.02 higher than the $488.03 rate in Merced. Both use the same code, release and participation basis.

43248 across payment areas

Same release and payment basis · bars start at $0

  1. Merced · This locality

    $488.03

  2. Bakersfield

    $489.05

    $1.02 higher than Merced

  3. Chico

    $488.03

    The same base rate than Merced

  4. El Centro

    $488.09

    $0.06 higher than Merced

  5. Fresno

    $488.03

    The same base rate than Merced

  6. Hanford-Corcoran

    $488.03

    The same base rate than Merced

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $522.36

    $34.33 higher than Merced

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 43248 ranges from $402.83 in Arkansas to $618.55 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

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

  • Madera

    California · 43248

    Office

    $488.03

    Facility

    $148.32

    The same base rate than Merced for the office setting.

  • Modesto

    California · 43248

    Office

    $488.03

    Facility

    $148.32

    The same base rate than Merced for the office setting.

  • Napa

    California · 43248

    Office

    $570.16

    Facility

    $161.63

    $82.13 higher than Merced for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 43248

    Office

    $520.31

    Facility

    $153.94

    $32.28 higher than Merced for the office setting.

  • Redding

    California · 43248

    Office

    $488.03

    Facility

    $148.32

    The same base rate than Merced for the office setting.

  • Rest Of California

    California · 43248

    Office

    $488.03

    Facility

    $148.32

    The same base rate than Merced for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 43248

    Office

    $491.73

    Facility

    $152.01

    $3.70 higher than Merced for the office setting.

  • Sacramento-Roseville-Folsom

    California · 43248

    Office

    $513.40

    Facility

    $152.92

    $25.37 higher than Merced for the office setting.

  • Salinas

    California · 43248

    Office

    $511.52

    Facility

    $152.28

    $23.49 higher than Merced for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 43248

    Office

    $524.51

    Facility

    $153.79

    $36.48 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 43248

    Office

    $605.00

    Facility

    $167.95

    $116.97 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 43248

    Office

    $604.61

    Facility

    $167.57

    $116.58 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 43248

    Office

    $618.55

    Facility

    $171.59

    $130.52 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 43248

    Office

    $616.97

    Facility

    $170.01

    $128.94 higher than Merced for the office setting.

  • San Luis Obispo-Paso Robles

    California · 43248

    Office

    $503.16

    Facility

    $150.11

    $15.13 higher than Merced for the office setting.

  • Santa Cruz-Watsonville

    California · 43248

    Office

    $530.27

    Facility

    $153.67

    $42.24 higher than Merced for the office setting.

  • Santa Maria-Santa Barbara

    California · 43248

    Office

    $513.70

    Facility

    $152.28

    $25.67 higher than Merced for the office setting.

  • Santa Rosa-Petaluma

    California · 43248

    Office

    $535.69

    Facility

    $155.06

    $47.66 higher than Merced for the office setting.

  • Stockton

    California · 43248

    Office

    $488.03

    Facility

    $148.32

    The same base rate than Merced for the office setting.

  • Vallejo

    California · 43248

    Office

    $569.60

    Facility

    $161.08

    $81.57 higher than Merced for the office setting.

  • Visalia

    California · 43248

    Office

    $488.03

    Facility

    $148.32

    The same base rate than Merced for the office setting.

  • Yuba City

    California · 43248

    Office

    $488.03

    Facility

    $148.32

    The same base rate than Merced for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 43248

    Office

    $526.94

    Facility

    $161.80

    $38.91 higher than Merced for the office setting.

  • Miami

    Florida · 43248

    Office

    $489.71

    Facility

    $167.04

    $1.68 higher than Merced for the office setting.

  • Chicago

    Illinois · 43248

    Office

    $475.06

    Facility

    $163.55

    $12.97 lower than Merced for the office setting.

  • Manhattan

    New York · 43248

    Office

    $527.63

    Facility

    $167.46

    $39.60 higher than Merced for the office setting.

  • Alaska*

    Alaska · 43248

    Office

    $523.12

    Facility

    $193.01

    $35.09 higher than Merced for the office setting.

  • Alabama

    Alabama · 43248

    Office

    $409.03

    Facility

    $137.82

    $79.00 lower than Merced for the office setting.

  • Arkansas

    Arkansas · 43248

    Office

    $402.83

    Facility

    $136.57

    $85.20 lower than Merced for the office setting.

  • Arizona

    Arizona · 43248

    Office

    $445.39

    Facility

    $145.04

    $42.64 lower than Merced for the office setting.

  • Colorado

    Colorado · 43248

    Office

    $479.09

    Facility

    $149.29

    $8.94 lower than Merced for the office setting.

  • Connecticut

    Connecticut · 43248

    Office

    $489.29

    Facility

    $155.46

    $1.26 higher than Merced for the office setting.

  • Delaware

    Delaware · 43248

    Office

    $453.03

    Facility

    $146.79

    $35.00 lower than Merced for the office setting.

  • Fort Lauderdale

    Florida · 43248

    Office

    $471.67

    Facility

    $157.68

    $16.36 lower than Merced for the office setting.

  • Rest Of Florida

    Florida · 43248

    Office

    $448.16

    Facility

    $151.84

    $39.87 lower than Merced for the office setting.

  • Atlanta

    Georgia · 43248

    Office

    $466.12

    Facility

    $151.20

    $21.91 lower than Merced for the office setting.

  • Rest Of Georgia

    Georgia · 43248

    Office

    $422.12

    Facility

    $145.64

    $65.91 lower than Merced for the office setting.

  • Hawaii, Guam

    Hawaii · 43248

    Office

    $501.33

    Facility

    $148.90

    $13.30 higher than Merced for the office setting.

  • Iowa

    Iowa · 43248

    Office

    $421.18

    Facility

    $137.57

    $66.85 lower than Merced for the office setting.

  • Idaho

    Idaho · 43248

    Office

    $423.80

    Facility

    $138.64

    $64.23 lower than Merced for the office setting.

  • East St. Louis

    Illinois · 43248

    Office

    $441.30

    Facility

    $156.14

    $46.73 lower than Merced for the office setting.

  • Rest Of Illinois

    Illinois · 43248

    Office

    $433.72

    Facility

    $150.73

    $54.31 lower than Merced for the office setting.

  • Suburban Chicago

    Illinois · 43248

    Office

    $476.85

    Facility

    $158.52

    $11.18 lower than Merced for the office setting.

  • Indiana

    Indiana · 43248

    Office

    $426.41

    Facility

    $139.08

    $61.62 lower than Merced for the office setting.

  • Kansas

    Kansas · 43248

    Office

    $418.53

    Facility

    $138.33

    $69.50 lower than Merced for the office setting.

  • Kentucky

    Kentucky · 43248

    Office

    $417.92

    Facility

    $142.37

    $70.11 lower than Merced for the office setting.

  • New Orleans

    Louisiana · 43248

    Office

    $438.72

    Facility

    $147.05

    $49.31 lower than Merced for the office setting.

  • Rest Of Louisiana

    Louisiana · 43248

    Office

    $417.00

    Facility

    $142.69

    $71.03 lower than Merced for the office setting.

  • Metropolitan Boston

    Massachusetts · 43248

    Office

    $528.80

    Facility

    $158.71

    $40.77 higher than Merced for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 43248

    Office

    $475.78

    Facility

    $149.39

    $12.25 lower than Merced for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 43248

    Office

    $487.81

    Facility

    $155.22

    $0.22 lower than Merced for the office setting.

  • Rest Of Maryland

    Maryland · 43248

    Office

    $462.16

    Facility

    $148.48

    $25.87 lower than Merced for the office setting.

  • Rest Of Maine

    Maine · 43248

    Office

    $425.50

    Facility

    $140.33

    $62.53 lower than Merced for the office setting.

  • Southern Maine

    Maine · 43248

    Office

    $450.57

    Facility

    $143.40

    $37.46 lower than Merced for the office setting.

  • Detroit

    Michigan · 43248

    Office

    $453.41

    Facility

    $154.30

    $34.62 lower than Merced for the office setting.

  • Rest Of Michigan

    Michigan · 43248

    Office

    $428.79

    Facility

    $145.80

    $59.24 lower than Merced for the office setting.

  • Minnesota

    Minnesota · 43248

    Office

    $460.13

    Facility

    $141.18

    $27.90 lower than Merced for the office setting.

  • Metropolitan Kansas City

    Missouri · 43248

    Office

    $436.21

    Facility

    $145.16

    $51.82 lower than Merced for the office setting.

  • Metropolitan St. Louis

    Missouri · 43248

    Office

    $441.07

    Facility

    $145.98

    $46.96 lower than Merced for the office setting.

  • Rest Of Missouri

    Missouri · 43248

    Office

    $409.09

    Facility

    $141.91

    $78.94 lower than Merced for the office setting.

  • Mississippi

    Mississippi · 43248

    Office

    $406.07

    Facility

    $139.20

    $81.96 lower than Merced for the office setting.

  • Montana**

    Montana · 43248

    Office

    $457.90

    Facility

    $147.94

    $30.13 lower than Merced for the office setting.

  • North Carolina

    North Carolina · 43248

    Office

    $430.26

    Facility

    $141.07

    $57.77 lower than Merced for the office setting.

  • North Dakota**

    North Dakota · 43248

    Office

    $451.18

    Facility

    $141.22

    $36.85 lower than Merced for the office setting.

  • Nebraska

    Nebraska · 43248

    Office

    $423.78

    Facility

    $137.69

    $64.25 lower than Merced for the office setting.

  • New Hampshire

    New Hampshire · 43248

    Office

    $470.93

    Facility

    $148.26

    $17.10 lower than Merced for the office setting.

  • Northern Nj

    New Jersey · 43248

    Office

    $520.95

    Facility

    $161.39

    $32.92 higher than Merced for the office setting.

  • Rest Of New Jersey

    New Jersey · 43248

    Office

    $495.18

    Facility

    $156.70

    $7.15 higher than Merced for the office setting.

  • New Mexico

    New Mexico · 43248

    Office

    $431.02

    Facility

    $146.78

    $57.01 lower than Merced for the office setting.

  • Nevada**

    Nevada · 43248

    Office

    $456.38

    Facility

    $146.11

    $31.65 lower than Merced for the office setting.

  • Nyc Suburbs/Long Island

    New York · 43248

    Office

    $540.20

    Facility

    $171.66

    $52.17 higher than Merced for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 43248

    Office

    $497.99

    Facility

    $158.59

    $9.96 higher than Merced for the office setting.

  • Queens

    New York · 43248

    Office

    $533.03

    Facility

    $166.66

    $45.00 higher than Merced for the office setting.

  • Rest Of New York

    New York · 43248

    Office

    $436.97

    Facility

    $142.51

    $51.06 lower than Merced for the office setting.

  • Ohio

    Ohio · 43248

    Office

    $427.42

    Facility

    $144.42

    $60.61 lower than Merced for the office setting.

  • Oklahoma

    Oklahoma · 43248

    Office

    $417.76

    Facility

    $140.97

    $70.27 lower than Merced for the office setting.

  • Portland

    Oregon · 43248

    Office

    $495.58

    Facility

    $151.21

    $7.55 higher than Merced for the office setting.

  • Rest Of Oregon

    Oregon · 43248

    Office

    $453.15

    Facility

    $144.43

    $34.88 lower than Merced for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 43248

    Office

    $476.25

    Facility

    $153.58

    $11.78 lower than Merced for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 43248

    Office

    $428.46

    Facility

    $143.92

    $59.57 lower than Merced for the office setting.

  • Puerto Rico

    Puerto Rico · 43248

    Office

    $461.62

    Facility

    $148.25

    $26.41 lower than Merced for the office setting.

  • Rhode Island

    Rhode Island · 43248

    Office

    $470.11

    Facility

    $149.92

    $17.92 lower than Merced for the office setting.

  • South Carolina

    South Carolina · 43248

    Office

    $429.49

    Facility

    $143.09

    $58.54 lower than Merced for the office setting.

  • South Dakota**

    South Dakota · 43248

    Office

    $450.39

    Facility

    $140.43

    $37.64 lower than Merced for the office setting.

  • Tennessee

    Tennessee · 43248

    Office

    $420.66

    Facility

    $138.91

    $67.37 lower than Merced for the office setting.

  • Austin

    Texas · 43248

    Office

    $477.22

    Facility

    $149.28

    $10.81 lower than Merced for the office setting.

  • Beaumont

    Texas · 43248

    Office

    $425.47

    Facility

    $143.40

    $62.56 lower than Merced for the office setting.

  • Brazoria

    Texas · 43248

    Office

    $453.02

    Facility

    $145.85

    $35.01 lower than Merced for the office setting.

  • Dallas

    Texas · 43248

    Office

    $455.76

    Facility

    $147.04

    $32.27 lower than Merced for the office setting.

  • Fort Worth

    Texas · 43248

    Office

    $452.39

    Facility

    $146.77

    $35.64 lower than Merced for the office setting.

  • Galveston

    Texas · 43248

    Office

    $454.27

    Facility

    $146.48

    $33.76 lower than Merced for the office setting.

  • Houston

    Texas · 43248

    Office

    $460.49

    Facility

    $152.70

    $27.54 lower than Merced for the office setting.

  • Rest Of Texas

    Texas · 43248

    Office

    $438.89

    Facility

    $144.74

    $49.14 lower than Merced for the office setting.

  • Utah

    Utah · 43248

    Office

    $435.67

    Facility

    $144.30

    $52.36 lower than Merced for the office setting.

  • Virginia

    Virginia · 43248

    Office

    $448.61

    Facility

    $143.92

    $39.42 lower than Merced for the office setting.

  • Virgin Islands

    United States Virgin Islands · 43248

    Office

    $461.62

    Facility

    $148.25

    $26.41 lower than Merced for the office setting.

  • Vermont

    Vermont · 43248

    Office

    $448.80

    Facility

    $141.94

    $39.23 lower than Merced for the office setting.

  • Rest Of Washington

    Washington · 43248

    Office

    $475.09

    Facility

    $148.70

    $12.94 lower than Merced for the office setting.

  • Seattle (King Cnty)

    Washington · 43248

    Office

    $540.43

    Facility

    $160.11

    $52.40 higher than Merced for the office setting.

  • Wisconsin

    Wisconsin · 43248

    Office

    $435.30

    Facility

    $138.35

    $52.73 lower than Merced for the office setting.

  • West Virginia

    West Virginia · 43248

    Office

    $416.75

    Facility

    $147.39

    $71.28 lower than Merced for the office setting.

  • Wyoming**

    Wyoming · 43248

    Office

    $454.97

    Facility

    $145.01

    $33.06 lower than Merced for the office setting.

See how rates vary across the country

43248 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$402.83

$553.29

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$523.121
AL$409.031
AR$402.831
AZ$445.391
CA$488.03–$618.5529
CO$479.091
CT$489.291
DC$526.941
DE$453.031
FL$448.16–$489.713
GA$422.12–$466.122
GU$501.331
HI$501.331
IA$421.181
ID$423.801
IL$433.72–$476.854
IN$426.411
KS$418.531
KY$417.921
LA$417.00–$438.722
MA$475.78–$528.802
MD$462.16–$526.943
ME$425.50–$450.572
MI$428.79–$453.412
MN$460.131
MO$409.09–$441.073
MS$406.071
MT$457.901
NC$430.261
ND$451.181
NE$423.781
NH$470.931
NJ$495.18–$520.952
NM$431.021
NV$456.381
NY$436.97–$540.205
OH$427.421
OK$417.761
OR$453.15–$495.582
PA$428.46–$476.252
PR$461.621
RI$470.111
SC$429.491
SD$450.391
TN$420.661
TX$425.47–$477.228
UT$435.671
VA$448.61–$526.942
VI$461.621
VT$448.801
WA$475.09–$540.432
WI$435.301
WV$416.751
WY$454.971

Explore 43248 on the national rate map →

Where does this rate apply?

Merced is a Medicare payment area. Our Census mapping connects it to 24 cities and communities in California, 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.

Browse all communities in California →

Why are the office and facility amounts different?

For 43248 in Merced, the physician’s office rate is $488.03 and the facility-setting rate is $148.32: a difference of $339.71.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 43248 in Merced. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$536.83

$488.03 × 110% = $536.83

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.

Compare your contract offer →

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 43248 in Merced.

PPRRVU2026_Oct_nonQPP.csv

5,176

Code
43248
Physician work
2.84
Practice expense
10.53
Malpractice
0.34

GPCI2026.csv

15

Locality
Merced
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 43248 in Merced
ComponentRVULocality factorAdjusted
Physician work2.84× 1.0172.8883
Practice expense10.53× 1.09611.5409
Malpractice0.34× 0.5360.1822
Total RVUs14.6114
Conversion factor× 33.4009

Office / nonfacility rate, Merced$488.03

Open 43248 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work2.841.017
Practice expense10.531.096
Malpractice0.340.536

(2.84 × 1.017 + 10.53 × 1.096 + 0.34 × 0.536) × $33.4009 = $488.03

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work2.841.017
Practice expense1.251.096
Malpractice0.340.536

(2.84 × 1.017 + 1.25 × 1.096 + 0.34 × 0.536) × $33.4009 = $148.32

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

43248 · Office / nonfacility

$488.03

Effective 2026-10-01

The base rate is $72.11 higher than on 2025-10-01, moving from $415.92 to $488.03 (17.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

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

  1. January 1, 2026

    RVU26A

    $415.92changed to$488.03

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.91 changed to 2.84
    • Practice expense RVU 8.88 changed to 10.53
    • Malpractice RVU 0.36 changed to 0.34
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $415.92

    Held through RVU25B, RVU25C, RVU25D.

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 fromOffice / nonfacilityFacilityCMS release
2026-10-01$488.03$148.32RVU26D
2026-07-01$488.03$148.32RVU26C
2026-04-01$488.03$148.32RVU26B
2026-01-01$488.03$148.32RVU26A
2025-10-01$415.92$160.30RVU25D
2025-07-01$415.92$160.30RVU25C
2025-04-01$415.92$160.30RVU25B
2025-01-01$415.92$160.30RVU25A

43248 billing questions

How does this differ from code 43249?

Code 43248 represents dilation over a guide wire. Code 43249 is used for esophageal balloon dilation with a balloon smaller than 30 mm.

Can the diagnostic EGD be reported separately?

The endoscopic inspection is part of the therapeutic procedure when performed to guide the dilation. Do not separately report a diagnostic EGD for that same work.

What documentation supports code 43248?

Document the esophageal narrowing treated and that dilation was performed over a guide wire. The record should support that the service was not balloon dilation.

Should modifier 50 be appended?

No. Bilateral adjustment is inappropriate for this service, so modifier 50 should not be used.

How are related endoscopies handled when performed in the same session?

CMS endoscopy-family pricing applies when related endoscopies are performed together. The procedure has a 0-day global period, with same-day preoperative and postoperative care included.

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.

RVUs for 43248PPRRVU2026_Oct_nonQPP.csv, line 5,176 (RVU26D)
Geographic factors for MercedGPCI2026.csv, line 15 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet