$435.67
43248 is used for guidewire-assisted esophageal dilation without endoscopic stent deployment. Dilation performed as part of 43266 is included in that service.
On this page
CMS RVU26D · Effective 2026-10-01
43266 Endoscopic stent Medicare reimbursement rates in Utah
Report upper GI endoscopic stent placement when an endoscopist deploys a stent to maintain luminal patency or seal a leak during transoral EGD. Compare 43266 office and facility rates across CMS payment localities in Utah.
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 43266 in Utah?
Utah 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
$187.83
1 of 1 localities have a supported rate.
Payment area: Utah
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 43266: Upper GI endoscopic stent placement
Report upper GI endoscopic stent placement when an endoscopist deploys a stent to maintain luminal patency or seal a leak during transoral EGD.
During flexible transoral EGD, the endoscopist advances and deploys a stent to maintain patency or seal a leak in the upper gastrointestinal tract. Typical cases include palliation of an obstructing esophageal tumor and endoscopic treatment of a selected luminal narrowing or leak. Gastroenterologists and therapeutic endoscopists perform this service in a hospital or ambulatory endoscopy facility.
Report 43266 for stent deployment; the service includes guidewire passage and pre- or post-dilation when performed. The record should identify the target, indication, stent placement, and any dilation performed. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43266
- 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 RVU3.82 · 66%
- Practice expense (office) RVU1.46 · 25%
- Malpractice RVU0.48 · 8%
6.2K
Medicare services in 2024 · #1738 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.
43266 compared with similar codes
Office rates for Utah, from the same CMS release.
$1,114.35
43249 describes balloon dilation of the esophagus, not placement of an endoscopic stent. Choose 43266 when a stent is deployed.
No office rate
43274 is an ERCP service for stent placement in a bile or pancreatic duct; 43266 is for stent placement during transoral EGD.
Compare 43266 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
Utah →
Office / nonfacility
Unavailable
Facility
$187.83
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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 43266 in Utah.
PPRRVU2026_Oct_nonQPP.csv
5,194
- Code
- 43266
- Physician work
- 3.82
- Practice expense
- 1.46
- Malpractice
- 0.48
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.82 | × 1.000 | 3.8200 |
| Practice expense | 1.46 | × 0.940 | 1.3724 |
| Malpractice | 0.48 | × 0.898 | 0.4310 |
| Total RVUs | 5.6234 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$187.83
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.82 | 1 |
| Practice expense | 1.46 | 0.94 |
| Malpractice | 0.48 | 0.898 |
(3.82 × 1 + 1.46 × 0.94 + 0.48 × 0.898) × $33.4009 = $187.83
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.
43266 billing questions
Is dilation separately reported when it is performed to place the stent?
Pre- and post-dilation, along with guidewire passage when performed, are included in 43266. Do not separately report those steps as stand-alone services.
How is 43266 different from ERCP stent placement?
43266 describes stent placement during transoral EGD in the upper GI tract. Use the ERCP stent code when the stent is placed in a bile or pancreatic duct through ERCP.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The claim should reflect the procedures actually performed and documented.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 43266, and co-surgeons and team surgery are not permitted.
What documentation supports reporting 43266?
Document the clinical target and reason for stenting, the stent deployment, and any dilation performed. The record should distinguish stent placement from evaluation or dilation alone.
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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5,19243264,,Ercp remove duct calculi,A,,6.46,2.32,NA,2.32,,0.72,9.50,9.50,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
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5,19443266,,Egd endoscopic stent place,A,,3.82,1.46,NA,1.46,,0.48,5.76,5.76,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
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5,19643270,,Egd lesion ablation,A,,3.91,19.68,,1.57,,0.44,24.03,5.92,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,19743273,,Endoscopic pancreatoscopy,A,,2.18,0.64,NA,0.64,,0.23,3.05,3.05,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985