Billing code 43248: Esophageal dilationMedicare rate & RVUs in Illinois
Report guidewire-assisted esophageal dilation during upper endoscopy when a dilator is advanced over a wire to treat an esophageal narrowing.
Medicare pays $433.72–$476.85 for 43248 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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 43248 covers
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.
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 43248 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$433.72 to $476.85
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $475.06 | $163.55 |
| East St. Louis | $441.30 | $156.14 |
| Rest Of Illinois | $433.72 | $150.73 |
| Suburban Chicago | $476.85 | $158.52 |
How the 43248 rate is calculated
Each of 43248’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 · 43248
RVUs × geographic indexes × conversion factor
Work2.84
2.84 RVUs× 1.000 GPCI
Practice expense10.53
10.53 RVUs× 1.000 GPCI
Malpractice0.34
0.34 RVUs× 1.000 GPCI
Adjusted RVUs
13.7100
Conversion factor
$33.4009
Medicare rate
$457.93
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43248
The CMS indicators that decide how 43248 is paid alongside other services.
CMS payment indicators · 43248
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
43248 without 51 · national office
$457.93
Esophageal dilation
43248-51 · Second procedure: 50%
$228.97
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%).
43248 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43249Esophageal dilation
- Use 43248 for dilation over a guide wire; use 43249 when the esophagus is dilated with a balloon smaller than 30 mm.
- 43245EGD dilation
- Code 43245 describes dilation of the gastric outlet, not dilation of an esophageal narrowing.
- 43241Endoscopic tube placement
- Code 43241 concerns placement of an intraluminal tube or catheter; it does not represent guidewire-assisted esophageal dilation.
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 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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