$884.46
Choose 43220 for balloon dilation under 30 mm. This code is for a balloon 30 mm or larger.
On this page
CMS RVU26D · Effective 2026-10-01
43214 Esophageal dilation Medicare reimbursement rates in Nebraska
Reports flexible esophagoscopy with balloon dilation using a balloon 30 mm or larger to treat an esophageal narrowing or obstruction. Compare 43214 office and facility rates across CMS payment localities in Nebraska.
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 43214 in Nebraska?
Nebraska 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
$154.82
1 of 1 localities have a supported rate.
Payment area: Nebraska
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.
Gastroenterology
About 43214: Esophagoscopy with large-balloon dilation
Reports flexible esophagoscopy with balloon dilation using a balloon 30 mm or larger to treat an esophageal narrowing or obstruction.
A gastroenterologist or other qualified endoscopist advances a flexible scope through the mouth to examine the esophagus and dilates a narrowed area with a balloon measuring 30 mm or larger. This approach may be used for a tight esophageal narrowing or for pneumatic dilation in a patient with achalasia. The balloon diameter is the key distinction from smaller-balloon esophagoscopy codes; an upper endoscopy that also examines the stomach or duodenum is a different service.
Report the code when the documented procedure supports flexible esophagoscopy and dilation with the required balloon size. The operative report should identify the treated esophageal site, dilation technique, and balloon diameter. Related endoscopies performed together are subject to endoscopy-family pricing. The code has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate. Medicare does not pay for an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 43214
- 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 RVU3.32 · 66%
- Practice expense (office) RVU1.22 · 24%
- Malpractice RVU0.50 · 10%
262
Medicare services in 2024 · #4098 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.
43214 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
43233 describes EGD with large-balloon esophageal dilation. Choose based on whether the service includes the broader upper endoscopic examination rather than esophagoscopy alone.
$382.26
43226 describes esophageal endoscopic dilation by a different technique. This code specifically requires balloon dilation with a diameter of 30 mm or larger.
Compare 43214 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
Nebraska →
Office / nonfacility
Unavailable
Facility
$154.82
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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 43214 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
5,151
- Code
- 43214
- Physician work
- 3.32
- Practice expense
- 1.22
- Malpractice
- 0.50
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.32 | × 1.000 | 3.3200 |
| Practice expense | 1.22 | × 0.923 | 1.1261 |
| Malpractice | 0.50 | × 0.378 | 0.1890 |
| Total RVUs | 4.6351 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nebraska$154.82
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.32 | 1 |
| Practice expense | 1.22 | 0.923 |
| Malpractice | 0.5 | 0.378 |
(3.32 × 1 + 1.22 × 0.923 + 0.5 × 0.378) × $33.4009 = $154.82
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.
43214 billing questions
How does this code differ from 43220?
The balloon diameter distinguishes the services: this code is for a balloon 30 mm or larger, while 43220 is for a balloon under 30 mm.
Can this be reported for an EGD that includes stomach examination?
Use the EGD dilation code when the service includes examination of the stomach or duodenum. This code describes esophagoscopy with large-balloon dilation.
What documentation supports the balloon-size selection?
Document the esophageal treatment site, the dilation performed, and the balloon diameter. The record should support use of a balloon measuring at least 30 mm.
Is same-day care included in the payment?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can modifier 50 or an assistant-at-surgery modifier be used?
Modifier 50 is inappropriate for this service. Medicare does not pay for an assistant at surgery for this code.
What happens when another related endoscopy is performed during the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. Review the combined procedures under the applicable endoscopy-family pricing rules.
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.
5,14843211,,Esophagoscop mucosal resect,A,,4.10,1.64,NA,1.64,,0.45,6.19,6.19,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,14943212,,Esophagoscop stent placement,A,,3.32,1.25,NA,1.25,,0.51,5.08,5.08,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15043213,,Esophagoscopy retro balloon,A,,4.51,32.37,,1.57,,0.67,37.55,6.75,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15143214,,Esophagosc dilate balloon 30,A,,3.32,1.22,NA,1.22,,0.50,5.04,5.04,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15243215,,Esophagoscopy flex remove fb,A,,2.38,10.33,,1.08,,0.36,13.07,3.82,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15343216,,Esophagoscopy lesion removal,A,,2.24,11.13,,1.09,,0.24,13.61,3.57,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15443217,,Esophagoscopy snare les remv,A,,2.73,10.98,,1.23,,0.30,14.01,4.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068