No office rate
Both describe rigid transoral esophageal dilation, but 43196 uses a guide wire to direct dilation rather than a balloon.
On this page
CMS RVU26D · Effective 2026-10-01
43195 Esophageal dilation Medicare reimbursement rates in Kentucky
Reports transoral rigid esophageal examination with balloon dilation to treat a narrowing, such as a stricture, during the same procedure. Compare 43195 office and facility rates across CMS payment localities in Kentucky.
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 43195 in Kentucky?
Kentucky 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
$153.10
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Endoscopy
About 43195: Rigid esophagoscopy with balloon dilation
Reports transoral rigid esophageal examination with balloon dilation to treat a narrowing, such as a stricture, during the same procedure.
The physician passes a rigid scope through the mouth to reach the esophagus and uses an inflatable balloon to widen a narrowed segment. This approach may be used for an esophageal stricture or other stenosis. Otolaryngologists and thoracic surgeons commonly perform rigid esophagoscopy in an operating room or hospital procedure setting; the documented service should show that balloon dilation was performed, not just inspection.
Choose this code when the dilation is performed with a balloon through a rigid transoral scope. Record the treated site and findings, the dilation performed, and relevant balloon details. CMS 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 for this service. Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 43195
- 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 RVU2.99 · 63%
- Practice expense (office) RVU1.35 · 28%
- Malpractice RVU0.43 · 9%
700
Medicare services in 2024 · #3260 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.
43195 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$1,059.26
This is the flexible endoscopic balloon-dilation option; 43195 uses a rigid transoral scope.
No office rate
43191 is for diagnostic rigid esophagoscopy. Choose 43195 when the service includes balloon dilation of an esophageal narrowing.
No office rate
43193 reports biopsy during rigid esophagoscopy; 43195 reports balloon dilation, not tissue sampling.
Compare 43195 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$153.10
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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 43195 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,136
- Code
- 43195
- Physician work
- 2.99
- Practice expense
- 1.35
- Malpractice
- 0.43
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.99 | × 1.000 | 2.9900 |
| Practice expense | 1.35 | × 0.889 | 1.2002 |
| Malpractice | 0.43 | × 0.915 | 0.3935 |
| Total RVUs | 4.5836 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$153.10
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.99 | 1 |
| Practice expense | 1.35 | 0.889 |
| Malpractice | 0.43 | 0.915 |
(2.99 × 1 + 1.35 × 0.889 + 0.43 × 0.915) × $33.4009 = $153.10
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.
43195 billing questions
When should this code be chosen instead of 43196?
Use 43195 for balloon dilation through a rigid transoral scope. Code 43196 describes dilation performed over an inserted guide wire.
Can a diagnostic esophagoscopy be separately reported with the dilation?
When related endoscopies are performed together, CMS endoscopy family pricing applies. The documentation should identify the actual procedures performed; do not assume a separate diagnostic endoscopy receives independent payment.
What documentation supports reporting this service?
Document the rigid transoral approach, the esophageal narrowing and its location, and that balloon dilation was performed. Include pertinent details of the dilation, such as the balloon used.
Is modifier 50 appropriate if the esophagus is treated on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery reporting 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.
5,13343192,,Esophagoscp rig trnso inject,A,,2.72,1.28,NA,1.28,,0.40,4.40,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13443193,,Esophagoscp rig trnso biopsy,A,,2.72,1.30,NA,1.30,,0.41,4.43,4.43,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13543194,,Esophagoscp rig trnso rem fb,A,,3.42,0.94,NA,0.94,,0.48,4.84,4.84,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13643195,,Esophagoscopy rigid balloon,A,,2.99,1.35,NA,1.35,,0.43,4.77,4.77,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13743196,,Esophagoscp guide wire dilat,A,,3.23,1.46,NA,1.46,,0.45,5.14,5.14,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13843197,,Esophagoscopy flex dx brush,A,,1.48,4.21,,0.36,,0.21,5.90,2.05,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13943198,,Esophagosc flex trnsn biopsy,A,,1.77,4.51,,0.43,,0.25,6.53,2.45,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43197,33.4009,09,0,99,0.00,0.00,0.00
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
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631