$433.43
Choose 43216 when the esophageal lesion is removed with forceps or cautery. This code represents ablation rather than lesion extraction.
On this page
CMS RVU26D · Effective 2026-10-01
43229 Esophageal ablation Medicare reimbursement rates in Wisconsin
Reports flexible transoral esophagoscopy with energy-based treatment of an esophageal lesion, such as dysplastic Barrett’s tissue, rather than lesion excision. Compare 43229 office and facility rates across CMS payment localities in Wisconsin.
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 43229 in Wisconsin?
Wisconsin 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
$744.94
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
$163.22
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 43229: Flexible esophagoscopy with lesion ablation
Reports flexible transoral esophagoscopy with energy-based treatment of an esophageal lesion, such as dysplastic Barrett’s tissue, rather than lesion excision.
A gastroenterologist or other qualified endoscopist advances a flexible scope through the mouth to visualize and ablate targeted esophageal tissue. A typical setting is endoscopic treatment of Barrett’s esophagus with dysplasia; the treatment destroys the target tissue rather than removing it with forceps or a snare. The service is distinct from diagnostic inspection, biopsy, and endoscopic removal of a lesion.
Report the code when the documented service includes esophageal lesion ablation, not merely examination or tissue sampling. The procedure note should identify the treated esophageal site and lesion, the ablation performed, and the clinical indication. 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 for this descriptor and anatomy. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 43229
- 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 RVU3.40 · 15%
- Practice expense (office) RVU19.60 · 84%
- Malpractice RVU0.41 · 2%
1.3K
Medicare services in 2024 · #2757 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.
43229 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$445.61
Choose 43217 for esophageal lesion removal by snare. Use this code when the treatment destroys the target tissue by ablation instead.
$306.75
43235 is for diagnostic upper endoscopy without the lesion-ablation service. It does not describe therapeutic destruction of esophageal tissue.
Compare 43229 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
Wisconsin →
Office / nonfacility
$744.94
Facility
$163.22
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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 43229 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
5,158
- Code
- 43229
- Physician work
- 3.40
- Practice expense
- 19.60
- Malpractice
- 0.41
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.40 | × 1.000 | 3.4000 |
| Practice expense | 19.60 | × 0.958 | 18.7768 |
| Malpractice | 0.41 | × 0.308 | 0.1263 |
| Total RVUs | 22.3031 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$744.94
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.4 | 1 |
| Practice expense | 19.6 | 0.958 |
| Malpractice | 0.41 | 0.308 |
(3.4 × 1 + 19.6 × 0.958 + 0.41 × 0.308) × $33.4009 = $744.94
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.4 | 1 |
| Practice expense | 1.42 | 0.958 |
| Malpractice | 0.41 | 0.308 |
(3.4 × 1 + 1.42 × 0.958 + 0.41 × 0.308) × $33.4009 = $163.22
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.
43229 billing questions
How is ablation distinguished from endoscopic lesion removal?
Use this code for ablation of the esophageal target. Codes 43216 and 43217 describe lesion removal by specific techniques, including forceps or cautery and snare removal.
Can this code be reported for diagnostic esophagoscopy alone?
No. The service must include treatment by ablation; inspection or biopsy without ablation does not support this code.
Is modifier 50 appropriate for ablation on both sides of the esophagus?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor and anatomy.
How are related endoscopies priced when performed together?
CMS applies endoscopy-family pricing when related endoscopies are performed together, rather than pricing each related scope service independently.
Does Medicare pay an assistant or co-surgeon for this procedure?
An assistant at surgery is not paid for this 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.
5,15543220,,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
5,1594322F,,Crgvr prov w/ ed addl rsrcs,M,,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
5,16043231,,Esophagoscop ultrasound exam,A,,2.73,1.13,NA,1.13,,0.27,4.13,4.13,0,000,0.00,0.00,0.00,3,0,1,2,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
5,16143232,,Esophagoscopy w/us needle bx,A,,3.50,1.42,NA,1.42,,0.39,5.31,5.31,0,000,0.00,0.00,0.00,3,0,1,2,0,9,43200,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,