GI · CMS status A
43249
EGD with balloon dilation
EGD with transendoscopic balloon dilation.
Work RVU
3.16
2026 Medicare pays
$246.83
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 3.16 + Practice 3.92 + Malpractice 0.31 = 7.39 total
Work (your effort)Practice expenseMalpractice
When to use it
EGD with balloon dilation of esophagus or stomach.
Documentation checklist
- ✓Indication (stricture, achalasia, post-fundoplication).
- ✓Balloon size, duration, pre/post diameter.
- ✓Complications.
Common pitfalls
- !If diagnostic EGD with biopsy also done, modifier 59 on 43239 may be appropriate.
Common modifiers
59
Common ICD-10 pairings
K22.2K20.9
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.