# CPT 43249

> Medicare paid $1,120.58 for CPT 43249 in the office (non-facility) setting and $159.52 in a facility under the Q2 2020 Physician Fee Schedule, effective April 2020. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2020, when it increased 3.7%.

## 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: Q2 2020 (2020 B)
- Effective: April 1 – June 30, 2020
- Status indicator: A
- Office (non-facility) national allowed amount: $1120.58
- Facility national allowed amount: $159.52
- Sequestration: not applied

## RVUs and formula

- Work RVU: 2.67
- Office (non-facility) practice expense RVU: 28.07
- Facility practice expense RVU: 1.44
- Malpractice RVU: 0.31
- Conversion factor: 36.0896
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q2 2020)
- CMS file: https://www.cms.gov/files/zip/rvu20b-updated-05012020.zip
- Parsed file: PPRRVU20_APR.csv, row 9,536
- Canonical page: https://localishealth.com/cpt/43249/2020/A
- Release-specific citation URL: https://localishealth.com/cpt/43249/2020/B
- Last significant update: 2026-08-04T03:09:33+00:00