Billing code 43213: Esophageal dilationMedicare rate & RVUs in Guam
Reports flexible transoral esophagoscopy with retrograde balloon dilation when treatment of an esophageal narrowing uses a retrograde approach.
Medicare pays $1,392.91 for 43213 in the office in Guam (Hawaii, Guam). 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 43213 covers
This service combines flexible transoral esophagoscopy with balloon dilation of an esophageal narrowing using a retrograde approach. It is typically performed by a gastroenterologist or otolaryngologist in an endoscopy suite or operating room when the narrowing is approached from the opposite direction from standard antegrade balloon dilation. The record should identify the esophageal site, the narrowing treated, the retrograde technique, and the balloon dilation performed.
Report the procedure for the retrograde approach, not simply because a balloon was used; standard balloon dilation is distinguished by its approach and, in related codes, balloon diameter. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, 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.
43213 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $1,392.91 | $223.22 |
How the 43213 rate is calculated
Each of 43213’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 · 43213
RVUs × geographic indexes × conversion factor
Work4.51
4.51 RVUs× 1.000 GPCI
Practice expense32.37
32.37 RVUs× 1.000 GPCI
Malpractice0.67
0.67 RVUs× 1.000 GPCI
Adjusted RVUs
37.5500
Conversion factor
$33.4009
Medicare rate
$1,254.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43213
The CMS indicators that decide how 43213 is paid alongside other services.
CMS payment indicators · 43213
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
43213 without 51 · national office
$1,254.20
Esophageal dilation
43213-51 · Second procedure: 50%
$627.10
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%).
43213 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43214Esophageal dilation
- Choose 43213 for retrograde balloon dilation. 43214 is identified by balloon diameter of 30 mm or larger.
- 43220Esophageal dilation
- 43220 describes balloon dilation with a balloon under 30 mm; 43213 identifies a retrograde approach.
- 43226Esophageal dilation
- 43226 is for dilation over a guide wire. Use 43213 when the documented dilation uses the retrograde balloon technique.
43213 billing questions
How is 43213 distinguished from other esophageal balloon dilation codes?
43213 identifies retrograde balloon dilation. Codes such as 43220 and 43214 describe balloon dilation by diameter, while 43226 describes dilation over a guide wire.
What documentation supports reporting 43213?
Document the esophageal narrowing and site, the retrograde approach, and the balloon dilation performed. The record should make clear why the procedure was retrograde rather than a standard antegrade dilation.
Can modifier 50 be reported?
No. The anatomy or descriptor makes bilateral reporting with modifier 50 inappropriate.
How are related endoscopies handled when performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included in the 0-day global period.
Can an assistant, co-surgeon, or surgical team be reported?
Medicare does not pay an assistant at surgery for 43213. 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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