Billing code 43226: Esophageal dilationMedicare rate & RVUs in Delaware
Reports flexible transoral esophagoscopy with guidewire placement and dilation over the wire to treat an esophageal narrowing.
Medicare pays $410.36 for 43226 in the office in Delaware (Delaware). Which amount applies depends on the service address.
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 9 sections
What 43226 covers
A gastroenterologist or other qualified endoscopist uses a flexible scope passed through the mouth to examine the esophagus, place a guidewire, and dilate a narrowed segment over the wire. Common indications include an esophageal stricture causing difficulty swallowing. The service may be performed in an endoscopy center or hospital, and sometimes in an office setting.
Select this code when the dilation is performed over a guidewire; balloon dilation and retrograde approaches have distinct codes. Document the narrowing, the guidewire-assisted technique, and the dilation performed. The 0-day global period includes routine same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, 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.
43226 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $410.36 | $116.00 |
How the 43226 rate is calculated
Each of 43226’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 · 43226
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.18Practice expense 9.89Malpractice 0.36
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43226
The CMS indicators that decide how 43226 is paid alongside other services.
CMS payment indicators · 43226
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
43226 without 51 · national office
$415.17
Esophageal dilation
43226-51 · Second procedure: 50%
$207.59
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%).
43226 compared with similar codes
Compare codes
43226 vs 43220 vs 43214 vs 43233: national Medicare rates
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How to choose
- 43220Esophageal dilation
- 43226 involves dilation over a guidewire. Choose 43220 for balloon dilation under 30 mm.
- 43214Esophageal dilation
- 43226 describes guidewire-assisted dilation; 43214 is the esophageal balloon-dilation code for a diameter of 30 mm or larger.
- 43233Esophageal dilation
- 43233 reports upper endoscopy with balloon dilation at 30 mm or larger. 43226 is the guidewire-dilation service performed through flexible esophagoscopy.
43226 billing questions
When should this code be chosen over balloon-dilation codes?
Use 43226 when the esophagus is dilated over a guidewire. Balloon dilation is reported with a code specific to the balloon method and size.
Can the diagnostic esophagoscopy be billed separately?
The scope examination used to perform the dilation is part of the reported service; do not separately report a diagnostic examination for that same work.
What documentation supports 43226?
Document the esophageal narrowing, the flexible transoral approach, guidewire placement, and dilation over the wire.
Does modifier 50 apply if the narrowing involves both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; report the service performed without modifier 50.
Can an assistant or co-surgeon be reported?
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 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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