# CPT 43249

> Medicare paid $1,045.07 for CPT 43249 in the office (non-facility) setting and $162.00 in a facility under the Q4 2018 Physician Fee Schedule, effective October 2018. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2018, when it increased 1.0%.

## What it is

A flexible scope is passed through the mouth and down into the esophagus, stomach, and the first stretch of small intestine, and during the same session a balloon is inflated inside a narrowed segment of the esophagus to stretch it open. The dilation is what separates this from a purely diagnostic look or a biopsy-only exam. It covers dilation with a standard-diameter balloon; the much wider balloons used to stretch the valve at the bottom of the esophagus in achalasia are reported differently.

## Selected release

- Release: Q4 2018 (2018 D)
- Effective: October 1 – December 31, 2018
- Status indicator: A
- Office (non-facility) national allowed amount: $1045.07
- Facility national allowed amount: $162.00
- Sequestration: not applied

## RVUs and formula

- Work RVU: 2.67
- Office (non-facility) practice expense RVU: 26.01
- Facility practice expense RVU: 1.48
- Malpractice RVU: 0.35
- Conversion factor: 35.9996
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q4 2018)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu18d.zip
- Parsed file: PPRRVU18_OCT.csv, row 9,086
- Canonical page: https://localishealth.com/cpt/43249/2018/A
- Release-specific citation URL: https://localishealth.com/cpt/43249/2018/D
- Last significant update: 2026-08-04T03:08:37+00:00