CPT code 43291: Balloon removal2026 Medicare rate & RVUs in Utah
Reports transoral endoscopic removal of an intragastric balloon, typically after temporary endoscopic weight-loss treatment has ended or the device requires removal.
Medicare pays $481.34 for 43291 in the office in Utah (Utah). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 43291 covers
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.
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 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $481.34 | $138.80 |
How the 43291 rate is calculated
Each of 43291’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43291
RVUs × geographic indexes × conversion factor
Work2.73
2.73 RVUs× 1.000 GPCI
Practice expense12.14
12.14 RVUs× 1.000 GPCI
Malpractice0.30
0.30 RVUs× 1.000 GPCI
Adjusted RVUs
15.1700
Conversion factor
$33.4009
Medicare rate
$506.69
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43291
The CMS indicators that decide how 43291 is paid alongside other services.
CMS payment indicators · 43291
Balloon removal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43291 without 51 · national office
$506.69
Balloon removal
43291-51 · Second procedure: 50%
$253.35
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43291 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43290Balloon placement
- 43290 is for endoscopic balloon placement. Use 43291 for endoscopic removal of a previously placed intragastric balloon.
- 43235Upper GI endoscopy
- 43235 describes diagnostic upper endoscopy without balloon extraction. It does not represent removal of an intragastric balloon.
- 43239EGD with biopsy
- 43239 describes upper endoscopy with biopsy. Choose 43291 when the documented service is intragastric balloon removal, rather than biopsy.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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