$1,082.25
Both describe esophageal balloon dilation during upper endoscopy. The balloon size distinguishes them: 43233 is for 30 mm or larger, while 43249 is for less than 30 mm.
On this page
CMS RVU26D · Effective 2026-10-01
43233 Esophageal dilation Medicare reimbursement rates in Iowa
Reports upper endoscopy with balloon dilation of an esophageal narrowing using a balloon 30 mm or larger, including pneumatic dilation for achalasia. Compare 43233 office and facility rates across CMS payment localities in Iowa.
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 43233 in Iowa?
Iowa 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
No supported rate
Facility setting
$187.28
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Gastrointestinal endoscopy
About 43233: Upper endoscopy with large-balloon esophageal dilation
Reports upper endoscopy with balloon dilation of an esophageal narrowing using a balloon 30 mm or larger, including pneumatic dilation for achalasia.
A gastroenterologist or other qualified physician passes an upper endoscope through the mouth to examine the esophagus and perform balloon dilation with a balloon measuring 30 mm or larger. The service may be used for an esophageal narrowing or for pneumatic dilation in achalasia. It is commonly performed in a hospital endoscopy unit or ambulatory surgery center; office use is less common.
Choose this code based on the esophageal treatment and balloon diameter, not simply because an upper endoscopy was performed. The report should identify the esophageal indication and treatment site, document balloon size and dilation, and describe the findings and response. Medicare assigns 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. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 43233
- 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 RVU3.97 · 65%
- Practice expense (office) RVU1.52 · 25%
- Malpractice RVU0.62 · 10%
1.3K
Medicare services in 2024 · #2799 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.
43233 compared with similar codes
Office rates for Iowa, from the same CMS release.
$421.18
43233 describes large-balloon dilation. Choose 43248 when the esophagus is dilated over a guidewire instead.
$600.57
43233 treats an esophageal narrowing with a large balloon; 43245 describes dilation of the gastric outlet.
Compare 43233 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
Iowa →
Office / nonfacility
Unavailable
Facility
$187.28
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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 43233 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,162
- Code
- 43233
- Physician work
- 3.97
- Practice expense
- 1.52
- Malpractice
- 0.62
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.97 | × 1.000 | 3.9700 |
| Practice expense | 1.52 | × 0.915 | 1.3908 |
| Malpractice | 0.62 | × 0.397 | 0.2461 |
| Total RVUs | 5.6069 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$187.28
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.97 | 1 |
| Practice expense | 1.52 | 0.915 |
| Malpractice | 0.62 | 0.397 |
(3.97 × 1 + 1.52 × 0.915 + 0.62 × 0.397) × $33.4009 = $187.28
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.
43233 billing questions
When should 43233 be chosen instead of 43249?
Use 43233 for esophageal balloon dilation with a balloon 30 mm or larger. Code 43249 describes esophageal balloon dilation with a balloon smaller than 30 mm.
How does 43233 differ from guidewire dilation?
43233 describes balloon dilation using a balloon at least 30 mm in diameter. Code 43248 is used for esophageal dilation over a guidewire rather than this large-balloon service.
Can the diagnostic upper endoscopy be reported separately?
Do not report a separate diagnostic EGD code just for inspection performed as part of the dilation. When related endoscopies are performed together, Medicare applies endoscopy family pricing.
Is modifier 50 appropriate for this code?
No. The anatomy and service descriptor make bilateral reporting with modifier 50 inappropriate.
What should the procedure note document?
Document the esophageal indication and treatment site, the balloon diameter used, the dilation performed, and relevant findings and response. The balloon must measure 30 mm or larger for this code.
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.
5,1594322F,,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
5,16043231,,Esophagoscop ultrasound exam,A,,2.73,1.13,NA,1.13,,0.27,4.13,4.13,0,000,0.00,0.00,0.00,3,0,1,2,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,16143232,,Esophagoscopy w/us needle bx,A,,3.50,1.42,NA,1.42,,0.39,5.31,5.31,0,000,0.00,0.00,0.00,3,0,1,2,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,16243233,,Egd balloon dil esoph30 mm/>,A,,3.97,1.52,NA,1.52,,0.62,6.11,6.11,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16343235,,Egd diagnostic brush wash,A,,2.04,7.38,,1.03,,0.24,9.66,3.31,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,16443236,,Uppr gi scope w/submuc inj,A,,2.33,10.76,,1.10,,0.27,13.36,3.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,16543237,,Endoscopic us exam esoph,A,,3.38,1.42,NA,1.42,,0.38,5.18,5.18,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136