$1,071.40
Use 43248 for dilation over a guide wire; use 43249 when the esophagus is dilated with a balloon smaller than 30 mm.
On this page
CMS RVU26D · Effective 2026-10-01
43248 Esophageal dilation Medicare reimbursement rates in Kansas
Report guidewire-assisted esophageal dilation during upper endoscopy when a dilator is advanced over a wire to treat an esophageal narrowing. Compare 43248 office and facility rates across CMS payment localities in Kansas.
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 43248 in Kansas?
Kansas 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
$418.53
1 of 1 localities have a supported rate.
Payment area: Kansas
One mapped payment locality.
Facility setting
$138.33
1 of 1 localities have a supported rate.
Payment area: Kansas
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 43248: Guidewire esophageal dilation during EGD
Report guidewire-assisted esophageal dilation during upper endoscopy when a dilator is advanced over a wire to treat an esophageal narrowing.
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.
CMS billing rules for 43248
- 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 RVU2.84 · 21%
- Practice expense (office) RVU10.53 · 77%
- Malpractice RVU0.34 · 2%
122.8K
Medicare services in 2024 · #506 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.
43248 compared with similar codes
Office rates for Kansas, from the same CMS release.
$596.12
Code 43245 describes dilation of the gastric outlet, not dilation of an esophageal narrowing.
No office rate
Code 43241 concerns placement of an intraluminal tube or catheter; it does not represent guidewire-assisted esophageal dilation.
Compare 43248 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
Kansas →
Office / nonfacility
$418.53
Facility
$138.33
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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 43248 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
5,176
- Code
- 43248
- Physician work
- 2.84
- Practice expense
- 10.53
- Malpractice
- 0.34
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.84 | × 1.000 | 2.8400 |
| Practice expense | 10.53 | × 0.904 | 9.5191 |
| Malpractice | 0.34 | × 0.504 | 0.1714 |
| Total RVUs | 12.5305 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kansas$418.53
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.84 | 1 |
| Practice expense | 10.53 | 0.904 |
| Malpractice | 0.34 | 0.504 |
(2.84 × 1 + 10.53 × 0.904 + 0.34 × 0.504) × $33.4009 = $418.53
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.84 | 1 |
| Practice expense | 1.25 | 0.904 |
| Malpractice | 0.34 | 0.504 |
(2.84 × 1 + 1.25 × 0.904 + 0.34 × 0.504) × $33.4009 = $138.33
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.
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 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.
5,17343245,,Egd dilate stricture,A,,3.00,16.19,,1.28,,0.42,19.61,4.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17443246,,Egd place gastrostomy tube,A,,3.47,1.34,NA,1.34,,0.53,5.34,5.34,0,000,0.00,0.00,0.00,3,0,0,2,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17543247,,Egd remove foreign body,A,,3.03,9.35,,1.30,,0.38,12.76,4.71,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17643248,,Egd guide wire insertion,A,,2.84,10.53,,1.25,,0.34,13.71,4.43,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17743249,,Esoph egd dilation <30 mm,A,,2.60,32.44,,1.18,,0.30,35.34,4.08,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,1784324F,,Pt queried prkns complic,I,,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
5,17943250,,Egd cautery tumor polyp,A,,2.90,11.61,,1.25,,0.42,14.93,4.57,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958