No office rate
The balloon diameter distinguishes these transoral esophagoscopy codes: 43220 is for under 30 mm, while 43214 is for 30 mm or larger.
On this page
CMS RVU26D · Effective 2026-10-01
43220 Esophageal dilation Medicare reimbursement rates in Nebraska
Reports transoral flexible esophagoscopy with balloon dilation under 30 mm, commonly used to treat an esophageal narrowing such as a benign stricture or ring. Compare 43220 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 43220 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
$884.46
1 of 1 localities have a supported rate.
Payment area: Nebraska
One mapped payment locality.
Facility setting
$98.01
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 43220: Transoral esophagoscopy with small-balloon dilation
Reports transoral flexible esophagoscopy with balloon dilation under 30 mm, commonly used to treat an esophageal narrowing such as a benign stricture or ring.
A gastroenterologist or other endoscopist passes a flexible scope through the mouth to examine the esophagus and dilate a narrowing with a balloon smaller than 30 mm. Typical situations include treatment of a benign esophageal stricture or ring in an outpatient endoscopy unit or hospital. The procedure is limited to esophagoscopy; a service that examines the stomach or duodenum may fall under an EGD code instead.
Report the code when the documentation supports transoral flexible esophagoscopy and balloon dilation, including the treated site and balloon diameter. It has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS applies endoscopy-family pricing. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43220
- 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 RVU1.95 · 7%
- Practice expense (office) RVU26.47 · 92%
- Malpractice RVU0.26 · 1%
1.8K
Medicare services in 2024 · #2559 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.
43220 compared with similar codes
Office rates for Nebraska, from the same CMS release.
$382.26
43226 describes dilation over a guide wire. Use 43220 when the documented service uses balloon dilation under 30 mm.
$1,090.72
43249 is an EGD with balloon dilation under 30 mm. 43220 is for esophagoscopy; distinguish them by the scope examination documented.
$1,157.03
43213 involves retrograde esophagoscopy for balloon dilation. 43220 is the transoral approach.
Compare 43220 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
$884.46
Facility
$98.01
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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 43220 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
5,155
- Code
- 43220
- Physician work
- 1.95
- Practice expense
- 26.47
- Malpractice
- 0.26
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.95 | × 1.000 | 1.9500 |
| Practice expense | 26.47 | × 0.923 | 24.4318 |
| Malpractice | 0.26 | × 0.378 | 0.0983 |
| Total RVUs | 26.4801 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Nebraska$884.46
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.95 | 1 |
| Practice expense | 26.47 | 0.923 |
| Malpractice | 0.26 | 0.378 |
(1.95 × 1 + 26.47 × 0.923 + 0.26 × 0.378) × $33.4009 = $884.46
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.95 | 1 |
| Practice expense | 0.96 | 0.923 |
| Malpractice | 0.26 | 0.378 |
(1.95 × 1 + 0.96 × 0.923 + 0.26 × 0.378) × $33.4009 = $98.01
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.
43220 billing questions
How does this differ from 43214?
Both describe transoral flexible esophagoscopy with balloon dilation. Use 43220 for a balloon under 30 mm; 43214 is for a balloon 30 mm or larger.
When would 43226 be a better fit?
43226 describes esophageal dilation over a guide wire. Choose based on the documented dilation technique, not simply because the same narrowing was treated.
Should an EGD dilation code be used instead?
Use an EGD code when the documented service is an upper endoscopy that includes examination beyond the esophagus. For EGD balloon dilation under 30 mm, compare 43249; for a balloon 30 mm or larger, compare 43233.
What should the procedure note include?
Document the transoral flexible esophagoscopy, the narrowing and its location, the balloon dilation performed, and the balloon diameter.
Can modifier 50 or an assistant-at-surgery claim be reported?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for the 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.
5,15243215,,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
5,15543220,,Esophagoscopy balloon <30mm,A,,1.95,26.47,,0.96,,0.26,28.68,3.17,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15643226,,Esoph endoscopy dilation,A,,2.18,9.89,,0.97,,0.36,12.43,3.51,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15743227,,Esophagoscopy control bleed,A,,2.82,16.44,,1.22,,0.36,19.62,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,15843229,,Esophagoscopy lesion ablate,A,,3.40,19.60,,1.42,,0.41,23.41,5.23,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
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