Billing code 43290: Balloon placementMedicare rate & RVUs in Florida
Reports endoscopic placement of an intragastric balloon for weight management, rather than diagnostic examination alone or later balloon removal.
Medicare pays $2,562.34–$2,791.89 for 43290 in the office in Florida, from Rest Of Florida to Miami. 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 43290 covers
A gastroenterologist or other endoscopist guides an intragastric balloon through the mouth and places it in the stomach during an upper endoscopic procedure. The service is used in balloon-based weight-management treatment, usually in an outpatient endoscopy setting or hospital outpatient facility. It represents placement, not removal of a balloon that was already in place.
Report this code when the balloon is actually placed; documentation should identify the endoscopic service and confirm placement. The procedure has 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, and co-surgeons and team surgery 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 43290 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$2562.34 to $2791.89
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $2,711.67 | $167.61 |
| Miami | $2,791.89 | $177.51 |
| Rest Of Florida | $2,562.34 | $161.43 |
How the 43290 rate is calculated
Each of 43290’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 · 43290
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.03Practice expense 76.51Malpractice 0.36
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43290
The CMS indicators that decide how 43290 is paid alongside other services.
CMS payment indicators · 43290
Balloon placement
| 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
43290 without 51 · national office
$2,668.73
Balloon placement
43290-51 · Second procedure: 50%
$1,334.37
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%).
43290 compared with similar codes
Compare codes
43290 vs 43291 vs 43235 vs 43239: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43291Balloon removal
- 43290 is for placing the intragastric balloon; 43291 is for removing one that is already in place.
- 43235Upper GI endoscopy
- 43235 describes diagnostic upper endoscopy. Use 43290 when the balloon is placed, rather than reporting diagnostic examination alone.
- 43239EGD with biopsy
- 43239 describes upper endoscopy with biopsy. It does not represent balloon placement; report biopsy only when tissue sampling is separately performed and documented.
43290 billing questions
How is placement distinguished from balloon removal?
Use 43290 for placing the intragastric balloon. Code 43291 describes endoscopic removal of an existing balloon.
Can a diagnostic EGD be reported separately?
The diagnostic inspection that is part of the balloon-placement procedure is not a separate service. A diagnostic EGD code is for an encounter in which no balloon placement is performed.
Should modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What happens when another related endoscopy is performed at the same session?
Endoscopy family pricing applies when related endoscopies are performed together. Documentation should identify each service actually performed.
Is an assistant or co-surgeon payable?
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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