$2,447.95–$2,587.54
43290 is for endoscopic balloon placement. Use 43291 for endoscopic removal of a previously placed intragastric balloon.
On this page
CMS RVU26D · Effective 2026-10-01
43291 Balloon removal Medicare reimbursement rates in Michigan
Reports transoral endoscopic removal of an intragastric balloon, typically after temporary endoscopic weight-loss treatment has ended or the device requires removal. Compare 43291 office and facility rates across CMS payment localities in Michigan.
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 43291 in Michigan?
Michigan has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$472.71–$499.37
2 of 2 localities have a supported rate.
Facility setting
$140.01–$147.72
2 of 2 localities have a supported rate.
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.
Gastroenterology
About 43291: Endoscopic intragastric balloon removal
Reports transoral endoscopic removal of an intragastric balloon, typically after temporary endoscopic weight-loss treatment has ended or the device requires removal.
A gastroenterologist or other qualified endoscopist uses a flexible endoscope passed through the mouth to retrieve an intragastric balloon from the stomach. The service is performed in an endoscopy setting, such as a hospital outpatient department or ambulatory surgery center, for a patient whose previously placed balloon is due for removal or needs to be taken out. This is the removal service, not the endoscopic placement service.
Report the code when the documented procedure includes endoscopic extraction of the intragastric balloon. The operative report should identify the balloon and describe its removal; an examination without extraction is not this service. 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. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 43291
- 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 RVU2.73 · 18%
- Practice expense (office) RVU12.14 · 80%
- Malpractice RVU0.30 · 2%
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.
43291 compared with similar codes
Office rates for Michigan, from the same CMS release.
$302.24–$319.52
43235 describes diagnostic upper endoscopy without balloon extraction. It does not represent removal of an intragastric balloon.
$391.13–$413.41
43239 describes upper endoscopy with biopsy. Choose 43291 when the documented service is intragastric balloon removal, rather than biopsy.
Compare 43291 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.
2 of 2 payment localities
Detroit →
Office / nonfacility
$499.37
Facility
$147.72
Rest Of Michigan →
Office / nonfacility
$472.71
Facility
$140.01
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43291 billing questions
How does removal differ from code 43290?
Code 43291 represents endoscopic removal of an intragastric balloon. Code 43290 represents endoscopic placement; select based on the service actually performed.
Can a diagnostic EGD be reported instead when the balloon is removed?
Use 43291 when the documented service includes balloon extraction. A diagnostic examination without removal is a different service; do not substitute it for documented removal.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are related endoscopies handled at the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included in the 0-day global period.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery billing 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.
5,21343289,,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
5,2194330F,,Cnslng epi spec sfty issues,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