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    v1.0.28
    OpenPayerBilling CodesEsophagoscopy ProceduresCPT cpt-43214-esophageal-balloon-dilation-endoscopic
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    CPT 43214: Endoscopic Esophageal Dilation with Balloon ≥30 mm

    Medicare pays $171 on average nationally for this procedure.

    CPT code 43214 describes endoscopic esophageal dilation performed by inserting a flexible endoscope through the mouth and using a balloon 30 mm in diameter or larger to dilate the esophagus; fluoroscopic guidance may be used and is included. This is an endoscopic therapeutic procedure performed in settings such as the endoscopy suite or hospital operating room and is billed as a dilation procedure using a flexible endoscope with a large-diameter balloon. Data not available in the input.

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old male with progressive dysphagia to solids and intermittent regurgitation presents to the outpatient endoscopy suite after an initial evaluation by a gastroenterologist. Prior workup includes history and physical, barium esophagram demonstrating a short-segment, symptomatic esophageal narrowing, and failure of conservative management (dietary modification and proton pump inhibitor therapy). The gastroenterologist schedules an elective therapeutic upper endoscopy with esophageal dilation using a large-diameter balloon.

    The patient arrives fasting to the ambulatory surgery center. Pre-procedure verification, consent, and anesthesia assessment are completed. The procedure is performed under monitored anesthesia care or general anesthesia in a procedure room equipped for fluoroscopy if real-time radiographic guidance is needed. A flexible endoscope is passed orally to the target stricture; a through-the-scope or over-the-wire 30 mm (or larger) balloon dilator is positioned across the stenosis and inflated per protocol. Fluoroscopy may be used to confirm balloon position and luminal caliber. Post-dilation endoscopic inspection ensures mucosal integrity and hemostasis. The patient is observed in recovery and given post-procedure instructions with return precautions for chest pain, fever, or worsening dysphagia.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43239Upper gastrointestinal endoscopy, flexible, transoral; with dilation of esophagus, by balloon dilation (any diameter)Alternative code for esophageal dilation when billing differing code sets; may be used depending on documentation and payer rules.
    43235Upper gastrointestinal endoscopy, flexible, transoral; with esophagogastroduodenoscopy, diagnostic, with biopsy, single or multiplePerformed before or after dilation when mucosal biopsies are required to evaluate underlying disease (e.g., eosinophilic esophagitis).
    43242Upper gastrointestinal endoscopy, flexible, transoral; with esophageal stent placement, including fluoroscopic guidance when performedMay be performed if dilation is unsuccessful or if a longer-term luminal scaffold is required for refractory strictures.
    43255Upper gastrointestinal endoscopy, flexible, transoral; with control of bleeding, any methodRelevant when bleeding occurs as a complication of dilation and endoscopic hemostasis is required.
    43450Repair of esophageal perforationRelevant in the rare event of full-thickness perforation requiring surgical repair after dilation.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RH0000XHematology (Internal Medicine) PhysicianAn internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
    2080P0206XPediatric Gastroenterology PhysicianA pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This speciali…
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    3245S0500XChildren's Substance Abuse Rehabilitation FacilityA facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the tre…
    363LP0808XPsychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    2088F0040XUrogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianA subspecialist in Urogynecology and Reconstructive Pelvic Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education …
    1744G0900XGraphics DesignerOther Service Providers · Specialist

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    E66.9Obesity, unspecified
    F50.9Eating disorder, unspecified
    I85.01Esophageal varices with bleeding
    I85.11Secondary esophageal varices with bleeding
    K21.9Gastro-esophageal reflux disease without esophagitis
    K22.0Achalasia of cardia
    K22.2Esophageal obstruction
    K25.9Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation
    K29.70Gastritis, unspecified, without bleeding
    K31.84Gastroparesis

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    7 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01

    Related Codes

    CPT-43180-HYPOPHARYNGEAL-CERVICAL-ESOPHAGEAL-DIVERTICULECTOMY-ENDOSCOPIC

    CPT 43180: Rigid Esophagoscopy with Diverticulectomy and Cricopharyngeal Myotomy

    CPT-43191-RIGID-ESOPHAGOSCOPY-ORAL-ENDOSCOPE

    CPT 43191: Rigid Esophagoscopy with Brushing or Washing

    CPT-43192-ESOPHAGEAL-SUBMUCOSAL-INJECTION-RIGID-ENDOSCOPE

    CPT 43192: Esophageal Submucosal Injection via Rigid Endoscope

    CPT-43193-RIGID-ESOPHAGOSCOPY-WITH-BIOPSY

    CPT 43193: Rigid Esophagoscopy with Biopsy

    CPT-43194-RIGID-ESOPHAGOSCOPY-FOREIGN-BODY-REMOVAL

    CPT 43194: Rigid Esophagoscopy with Foreign Body Removal

    CPT-43195-ESOPHAGEAL-BALLOON-DILATION-RIGID-ENDOSCOPE

    CPT 43195: Esophageal Balloon Dilation via Rigid Endoscope

    CPT-43196-RIGID-ESOPHAGOSCOPY-DILATION-GUIDEWIRE-DILATORS

    CPT 43196: Rigid Esophagoscopy with Guidewire and Dilation

    CPT-43197-TRANSNASAL-FLEXIBLE-ESOPHAGOSCOPY-BRUSHING-WASHINGS

    CPT 43197: Flexible Transnasal Esophagoscopy with Brushing

    CPT-43198-FLEXIBLE-NASAL-ESOPHAGOSCOPY-WITH-BIOPSY

    CPT 43198: Transnasal Flexible Esophagoscopy with Biopsy

    CPT-43200-ESOPHAGOGASTRODUODENOSCOPY-BRUSHING-WASHING-CYTOLOGY

    CPT 43200: Endoscopic Brushing or Washing for Specimen Collection

    Showing 1–10 of 28

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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