$462.79
43290 is for placing the intragastric balloon; 43291 is for removing one that is already in place.
On this page
CMS RVU26D · Effective 2026-10-01
43290 Balloon placement Medicare reimbursement rates in Kansas
Reports endoscopic placement of an intragastric balloon for weight management, rather than diagnostic examination alone or later balloon removal. Compare 43290 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 43290 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
$2417.44
1 of 1 localities have a supported rate.
Payment area: Kansas
One mapped payment locality.
Facility setting
$147.12
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 43290: Transoral intragastric balloon placement
Reports endoscopic placement of an intragastric balloon for weight management, rather than diagnostic examination alone or later balloon removal.
A gastroenterologist or other endoscopist guides an intragastric balloon through the mouth and places it in the stomach during an upper endoscopic procedure. The service is used in balloon-based weight-management treatment, usually in an outpatient endoscopy setting or hospital outpatient facility. It represents placement, not removal of a balloon that was already in place.
Report this code when the balloon is actually placed; documentation should identify the endoscopic service and confirm placement. The procedure has 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 for this service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43290
- 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 RVU3.03 · 4%
- Practice expense (office) RVU76.51 · 96%
- Malpractice RVU0.36 · 0%
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.
43290 compared with similar codes
Office rates for Kansas, from the same CMS release.
$295.01
43235 describes diagnostic upper endoscopy. Use 43290 when the balloon is placed, rather than reporting diagnostic examination alone.
$382.50
43239 describes upper endoscopy with biopsy. It does not represent balloon placement; report biopsy only when tissue sampling is separately performed and documented.
Compare 43290 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
$2417.44
Facility
$147.12
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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 43290 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
5,215
- Code
- 43290
- Physician work
- 3.03
- Practice expense
- 76.51
- Malpractice
- 0.36
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.03 | × 1.000 | 3.0300 |
| Practice expense | 76.51 | × 0.904 | 69.1650 |
| Malpractice | 0.36 | × 0.504 | 0.1814 |
| Total RVUs | 72.3765 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kansas$2417.44
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.03 | 1 |
| Practice expense | 76.51 | 0.904 |
| Malpractice | 0.36 | 0.504 |
(3.03 × 1 + 76.51 × 0.904 + 0.36 × 0.504) × $33.4009 = $2417.44
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.03 | 1 |
| Practice expense | 1.32 | 0.904 |
| Malpractice | 0.36 | 0.504 |
(3.03 × 1 + 1.32 × 0.904 + 0.36 × 0.504) × $33.4009 = $147.12
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.
43290 billing questions
How is placement distinguished from balloon removal?
Use 43290 for placing the intragastric balloon. Code 43291 describes endoscopic removal of an existing balloon.
Can a diagnostic EGD be reported separately?
The diagnostic inspection that is part of the balloon-placement procedure is not a separate service. A diagnostic EGD code is for an encounter in which no balloon placement is performed.
Should modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What happens when another related endoscopy is performed at the same session?
Endoscopy family pricing applies when related endoscopies are performed together. Documentation should identify each service actually performed.
Is an assistant or co-surgeon payable?
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.
5,21243288,,Esphg thrsc moblj,A,,64.76,22.49,NA,22.49,,16.45,103.70,103.70,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21343289,,Unlisted laps px esoph,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2144328F,,Pt asked re sleep disturb,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
5,21543290,,Egd flx trnsorl dplmnt balo,A,,3.03,76.51,,1.32,,0.36,79.90,4.71,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,21643291,,Egd flx trnsorl rmvl balo,A,,2.73,12.14,,1.23,,0.30,15.17,4.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,21743300,,Repair of esophagus,A,,9.10,6.10,NA,6.10,,1.32,16.52,16.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21843305,,Repair esophagus and fistula,A,,17.65,8.02,NA,8.02,,2.58,28.25,28.25,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,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