$1,177.78
43245 treats an obstructed gastric outlet. 43249 is for balloon dilation of an esophageal narrowing using a balloon smaller than 30 mm.
On this page
CMS RVU26D · Effective 2026-10-01
43245 EGD dilation Medicare reimbursement rates in Wyoming
Reports upper endoscopic dilation of an obstructed gastric outlet, such as a narrowed pylorus, to improve passage from the stomach. Compare 43245 office and facility rates across CMS payment localities in Wyoming.
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 43245 in Wyoming?
Wyoming 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
$651.34
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
Facility setting
$153.34
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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 43245: EGD gastric outlet stricture dilation
Reports upper endoscopic dilation of an obstructed gastric outlet, such as a narrowed pylorus, to improve passage from the stomach.
A gastroenterologist or other qualified endoscopist advances an upper endoscope to the stomach and dilates a narrowed gastric outlet to relieve obstruction. The target is the pyloric channel or another gastric outlet narrowing, not an esophageal stricture. Dilation may use a balloon or a guidewire-based technique. The service is performed in settings such as a hospital outpatient department or ambulatory surgery center, with the choice based on the patient and clinical circumstances.
Select this code when the treated narrowing is at the gastric outlet; esophageal dilation codes describe a different site. The report should identify the narrowing and its location, the indication for dilation, the method used, and the result. 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 service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43245
- 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 RVU3.00 · 15%
- Practice expense (office) RVU16.19 · 83%
- Malpractice RVU0.42 · 2%
14.1K
Medicare services in 2024 · #1289 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.
43245 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
43233 is for balloon dilation of an esophageal narrowing with a balloon 30 mm or larger; 43245 targets a gastric outlet obstruction.
$454.97
43248 concerns esophageal dilation using a guidewire. Use 43245 when the treated obstruction is at the gastric outlet.
Compare 43245 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
Wyoming** →
Office / nonfacility
$651.34
Facility
$153.34
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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 43245 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
5,173
- Code
- 43245
- Physician work
- 3.00
- Practice expense
- 16.19
- Malpractice
- 0.42
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.00 | × 1.000 | 3.0000 |
| Practice expense | 16.19 | × 1.000 | 16.1900 |
| Malpractice | 0.42 | × 0.740 | 0.3108 |
| Total RVUs | 19.5008 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wyoming**$651.34
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3 | 1 |
| Practice expense | 16.19 | 1 |
| Malpractice | 0.42 | 0.74 |
(3 × 1 + 16.19 × 1 + 0.42 × 0.74) × $33.4009 = $651.34
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3 | 1 |
| Practice expense | 1.28 | 1 |
| Malpractice | 0.42 | 0.74 |
(3 × 1 + 1.28 × 1 + 0.42 × 0.74) × $33.4009 = $153.34
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.
43245 billing questions
When should this code be chosen instead of 43249?
Use 43245 for dilation of a gastric outlet obstruction, such as a pyloric narrowing. Code 43249 describes balloon dilation of an esophageal narrowing.
Does this code include the diagnostic upper endoscopy?
The endoscopic examination used to locate and treat the gastric outlet narrowing is part of the dilation service. Do not report a separate diagnostic EGD for that same examination.
What documentation supports reporting this service?
Document the obstructing narrowing and its location, the clinical reason for dilation, the dilation technique, and the findings or outcome.
How does CMS price this with another endoscopy in the same session?
When related endoscopies are performed together, CMS applies endoscopy family pricing. The applicable payment reflects that pricing rule.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
Is modifier 50 appropriate for dilation on both sides?
No. Modifier 50 is inappropriate for this service because the descriptor or anatomy does not support bilateral reporting.
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.
5,17043242,,Egd us fine needle bx/aspir,A,,4.61,1.78,NA,1.78,,0.49,6.88,6.88,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17143243,,Egd injection varices,A,,4.16,1.57,NA,1.57,,0.53,6.26,6.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17243244,,Egd varices ligation,A,,4.29,1.69,NA,1.69,,0.47,6.45,6.45,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17343245,,Egd dilate stricture,A,,3.00,16.19,,1.28,,0.42,19.61,4.70,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17443246,,Egd place gastrostomy tube,A,,3.47,1.34,NA,1.34,,0.53,5.34,5.34,0,000,0.00,0.00,0.00,3,0,0,2,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17543247,,Egd remove foreign body,A,,3.03,9.35,,1.30,,0.38,12.76,4.71,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,17643248,,Egd guide wire insertion,A,,2.84,10.53,,1.25,,0.34,13.71,4.43,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
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,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,