$888.93
43226 involves dilation over a guidewire. Choose 43220 for balloon dilation under 30 mm.
On this page
CMS RVU26D · Effective 2026-10-01
43226 Esophageal dilation Medicare reimbursement rates in Indiana
Reports flexible transoral esophagoscopy with guidewire placement and dilation over the wire to treat an esophageal narrowing. Compare 43226 office and facility rates across CMS payment localities in Indiana.
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.
What does Medicare pay for 43226 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$384.88
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$108.69
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Gastroenterology
About 43226: Guidewire-assisted esophageal dilation
Reports flexible transoral esophagoscopy with guidewire placement and dilation over the wire to treat an esophageal narrowing.
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.
CMS billing rules for 43226
- 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 RVU2.18 · 18%
- Practice expense (office) RVU9.89 · 80%
- Malpractice RVU0.36 · 3%
1.4K
Medicare services in 2024 · #2716 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.
43226 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
43226 describes guidewire-assisted dilation; 43214 is the esophageal balloon-dilation code for a diameter of 30 mm or larger.
No office rate
43233 reports upper endoscopy with balloon dilation at 30 mm or larger. 43226 is the guidewire-dilation service performed through flexible esophagoscopy.
Compare 43226 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Indiana →
Office / nonfacility
$384.88
Facility
$108.69
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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 43226 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,156
- Code
- 43226
- Physician work
- 2.18
- Practice expense
- 9.89
- Malpractice
- 0.36
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.18 | × 1.000 | 2.1800 |
| Practice expense | 9.89 | × 0.927 | 9.1680 |
| Malpractice | 0.36 | × 0.486 | 0.1750 |
| Total RVUs | 11.5230 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$384.88
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.18 | 1 |
| Practice expense | 9.89 | 0.927 |
| Malpractice | 0.36 | 0.486 |
(2.18 × 1 + 9.89 × 0.927 + 0.36 × 0.486) × $33.4009 = $384.88
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.18 | 1 |
| Practice expense | 0.97 | 0.927 |
| Malpractice | 0.36 | 0.486 |
(2.18 × 1 + 0.97 × 0.927 + 0.36 × 0.486) × $33.4009 = $108.69
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.
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 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.
5,15343216,,Esophagoscopy lesion removal,A,,2.24,11.13,,1.09,,0.24,13.61,3.57,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15443217,,Esophagoscopy snare les remv,A,,2.73,10.98,,1.23,,0.30,14.01,4.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15543220,,Esophagoscopy balloon <30mm,A,,1.95,26.47,,0.96,,0.26,28.68,3.17,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15643226,,Esoph endoscopy dilation,A,,2.18,9.89,,0.97,,0.36,12.43,3.51,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15743227,,Esophagoscopy control bleed,A,,2.82,16.44,,1.22,,0.36,19.62,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15843229,,Esophagoscopy lesion ablate,A,,3.40,19.60,,1.42,,0.41,23.41,5.23,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,1594322F,,Crgvr prov w/ ed addl rsrcs,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915