$417.92
Choose 43249 for esophageal balloon dilation under 30 mm. Choose 43248 when the esophagus is dilated over a guide wire.
On this page
CMS RVU26D · Effective 2026-10-01
43249 Esophageal dilation Medicare reimbursement rates in Kentucky
Reports upper endoscopy with balloon dilation of an esophageal narrowing using a balloon diameter under 30 mm, commonly to relieve dysphagia. Compare 43249 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 43249 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
$1059.26
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$131.05
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.
Gastrointestinal endoscopy
About 43249: Esophageal balloon dilation under 30 mm
Reports upper endoscopy with balloon dilation of an esophageal narrowing using a balloon diameter under 30 mm, commonly to relieve dysphagia.
A gastroenterologist or other endoscopist advances an upper endoscope through the mouth to the esophagus and expands a balloon across a narrowed area. Common indications include dysphagia from a benign esophageal stricture or ring. The code is for dilation of the esophagus with a balloon under 30 mm; it is not the code for dilation of a gastric outlet. The service is commonly performed in an ambulatory endoscopy center or hospital outpatient department.
Select the code based on the site and dilation technique, and document the esophageal narrowing, balloon method, and maximum balloon diameter. Report the endoscopic procedure once for the session, not once per inflation. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. Endoscopy-family pricing applies when related endoscopies are performed together. Modifier 50 is inappropriate; assistant-at-surgery services are statutorily nonpayable, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 43249
- 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 RVU2.60 · 7%
- Practice expense (office) RVU32.44 · 92%
- Malpractice RVU0.30 · 1%
164.8K
Medicare services in 2024 · #426 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.
43249 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$593.77
43245 is for dilation of the gastric outlet. This code is for balloon dilation of an esophageal narrowing.
$381.23
43239 reports upper endoscopy with biopsy, not esophageal balloon dilation. It may be reported for a separately performed biopsy during the same session, subject to endoscopy-family pricing.
Compare 43249 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
$1059.26
Facility
$131.05
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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 43249 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,177
- Code
- 43249
- Physician work
- 2.60
- Practice expense
- 32.44
- Malpractice
- 0.30
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.60 | × 1.000 | 2.6000 |
| Practice expense | 32.44 | × 0.889 | 28.8392 |
| Malpractice | 0.30 | × 0.915 | 0.2745 |
| Total RVUs | 31.7137 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$1059.26
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.6 | 1 |
| Practice expense | 32.44 | 0.889 |
| Malpractice | 0.3 | 0.915 |
(2.6 × 1 + 32.44 × 0.889 + 0.3 × 0.915) × $33.4009 = $1059.26
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.6 | 1 |
| Practice expense | 1.18 | 0.889 |
| Malpractice | 0.3 | 0.915 |
(2.6 × 1 + 1.18 × 0.889 + 0.3 × 0.915) × $33.4009 = $131.05
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.
43249 billing questions
How does this differ from 43248?
43249 is for balloon dilation of the esophagus with a balloon under 30 mm. Use 43248 when dilation is performed over a guide wire.
Can this code be used for gastric outlet dilation?
No. This code is for dilation in the esophagus; 43245 describes dilation of the gastric outlet.
How many units should be reported if the balloon is inflated more than once?
Report the endoscopic dilation once for the session, not a separate unit for each inflation.
What documentation supports the code?
Document the esophageal narrowing, the balloon dilation technique, and the maximum balloon diameter used, which must be under 30 mm for this code.
Can modifier 50 be used, or can an assistant or co-surgeon be reported?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for it, and co-surgeon and team-surgery billing are not permitted.
Is same-day care included in the payment?
Yes. The 0-day global period includes same-day preoperative and postoperative care; related endoscopies performed together are subject to endoscopy-family pricing.
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.
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