CPT 43249
Global 000 ActiveEsoph egd dilation <30 mm
CPT 43249 Billing & Documentation Guide
CPT code 43249 (Esoph egd dilation <30 mm) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.6, a non-facility practice expense RVU of 32.44, and a malpractice RVU of 0.3, a total non-facility RVU of 35.34 and facility RVU of 4.08. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1228, though rates vary from $1022.75 to $1664.21 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43249, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 43249 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 43249 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 43249
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.6 | 2.6 |
| Practice Expense RVU | 32.44 | 1.18 |
| Malpractice RVU | 0.3 | 0.3 |
| Total RVU | 35.34 | 4.08 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43249
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1377.5 | $142.03 | $1281.23 - $1664.21 | 29 |
| Florida | $1193.48 | $145.89 | $1137.75 - $1240.13 | 3 |
| Georgia | $1132.65 | $136.56 | $1065.29 - $1200 | 2 |
| Illinois | $1153.25 | $144.38 | $1091.76 - $1217.99 | 4 |
| Michigan | $1118.38 | $137.95 | $1087.41 - $1149.34 | 2 |
| North Carolina | $1104.17 | $130.02 | $1104.17 - $1104.17 | 1 |
| New York | $1313.36 | $148.55 | $1123.24 - $1399.32 | 5 |
| Ohio | $1086.2 | $132.93 | $1086.2 - $1086.2 | 1 |
| Pennsylvania | $1159.65 | $136.94 | $1090.99 - $1228.31 | 2 |
| Texas | $1163.36 | $135.43 | $1082.16 - $1242.26 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 43249
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43249 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00520 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00731 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00732 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00740 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00810 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00811 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00812 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00813 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 43249
What does CPT code 43249 mean? +
CPT code 43249 represents: Esoph egd dilation <30 mm. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 43249? +
The 2026 Medicare national average non-facility payment for CPT 43249 is $1228. Rates range from $1022.75 to $1664.21 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43249? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 43249? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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