What Is CPT Code 43249?
CPT 43249 is the procedure code for an esophagogastroduodenoscopy (EGD) with transendoscopic balloon dilation of the esophagus, where the balloon measures less than 30 mm in diameter. It is a therapeutic code that includes the diagnostic EGD component, so a separate 43235 should not be reported in the same session. CPT 43249 is one of the most frequently billed esophageal dilation codes in gastroenterology, used primarily for benign esophageal strictures caused by GERD, radiation, surgical anastomosis, or eosinophilic esophagitis.
Balloon size is the code selector: 43249 applies when the balloon is under 30 mm. If the balloon is 30 mm or larger, the correct code is 43233.
Diagnostic EGD is included: Do not bill 43235 alongside 43249. The diagnostic examination is bundled into the therapeutic code.
Documentation drives payment: The operative note must specify balloon size, technique, number of inflations, and the esophageal segment treated. Missing any of these is the most common reason 43249 claims deny.
When to Use CPT 43249
CPT 43249 is reported when a gastroenterologist performs an EGD and dilates an esophageal stricture or narrowing using a through-the-scope (TTS) balloon catheter measuring less than 30 mm in diameter. The procedure is performed to restore luminal patency in patients who present with dysphagia, food impaction, or obstructive symptoms caused by a narrowed esophagus.
The most common clinical indications that support 43249 include benign peptic strictures from chronic GERD, which account for roughly 70% to 80% of esophageal strictures according to published gastroenterology literature; radiation-induced strictures in patients who have undergone treatment for head, neck, or thoracic cancers; anastomotic strictures following esophageal or gastric surgery; strictures associated with eosinophilic esophagitis, where the esophagus narrows due to chronic eosinophilic inflammation; and Schatzki rings at the gastroesophageal junction.
One question we hear constantly from GI practice managers is whether 43249 is the right code when the provider uses a balloon but also performs a biopsy in the same session. The answer depends on the documentation. If the biopsy is taken from the esophagus during the same EGD, CPT 43239 (EGD with biopsy) can be reported alongside 43249 with modifier 59 or XS, provided the biopsy and the dilation target different clinical indications and the note supports both as distinct services. CPT Assistant has addressed this pairing and confirmed it is reportable when properly documented. However, this is one of the most commonly audited pairings in GI billing, so the documentation must be airtight.
How Does 43249 Differ From 43233, 43248, and 43245?
Esophageal dilation codes split by method and by balloon size. Selecting the wrong one is a coding error that leads to denials, downcoding, or audit flags. The four EGD dilation codes that GI practices use most frequently are compared below.
| CPT Code | Description | Key Distinction | When to Use |
| 43249 | EGD with transendoscopic balloon dilation, esophagus, under 30 mm | Balloon under 30 mm | Balloon dilation of esophageal stricture with smaller balloon |
| 43233 | EGD with balloon dilation, esophagus, 30 mm or larger | Balloon 30 mm or larger | Achalasia, large-diameter dilation |
| 43248 | EGD with guidewire-directed dilation, esophagus | Guidewire, not balloon | Savary or bougie dilation over a guidewire |
| 43245 | EGD with dilation of gastric or duodenal stricture | Gastric or duodenal location | Pyloric stenosis, duodenal stricture |
The 30 mm threshold between 43249 and 43233 is the single most important distinction in esophageal dilation coding. If the operative note documents a balloon of 30 mm or larger, 43249 is wrong and 43233 is correct. If the note documents guidewire-directed dilation (Savary dilators passed over a guidewire rather than a balloon inflated through the scope), the correct code is 43248, not 43249. Across the billing companies we vet for GI practices, the 43249-versus-43233 mismatch is one of the top five coding errors in upper endoscopy billing, usually because the note describes the balloon as “large” without stating the actual diameter.
What Does CPT 43249 Reimburse in 2026?
Under the CMS 2026 Physician Fee Schedule, CPT 43249 carries a total RVU of approximately 5.69, which translates to a Medicare physician payment of roughly $190 to $210 depending on geographic locality. The facility fee for a hospital outpatient setting is billed separately by the facility. In an ambulatory surgery center, the total combined reimbursement (physician plus facility) typically runs higher than the office-based rate.
Commercial payer reimbursement for 43249 varies widely but generally falls between $250 and $500 for the physician component alone, depending on the contracted rate and the payer’s fee schedule. For practices performing esophageal dilations at volume, the per-case reimbursement is meaningful, and a coding error that pulls the wrong dilation code or triggers a medical-necessity denial puts real dollars at risk on every claim. To understand how the broader 2027 Medicare GI payment changes, including the proposed 3% endoscopy reduction, affect these rates going forward, see our full breakdown of the proposed rule.
Esophageal dilation billing turns on documentation details that generic billing teams miss: balloon size, technique, inflation count, and the right code when a biopsy happens in the same session. If your 43249 claims are denying or getting downcoded, get matched with a GI billing partner that codes dilation to the note. Comparing quotes is free.
Documentation Requirements for CPT 43249
The operative note is where 43249 claims are won or lost. Payers review the note against the code descriptor, and any missing element gives them a reason to deny. Every 43249 operative note should include the following.
1. Balloon diameter, confirmed as less than 30 mm. State the exact size in millimeters. “Large balloon” or “small balloon” without a number is the single most common documentation gap that triggers denials or post-payment audits.
2. Dilation technique. Confirm that a through-the-scope (TTS) balloon catheter was used, not a guidewire-directed dilator. The technique determines whether the correct code is 43249 or 43248.
3. Number of inflations and pressures applied. Document how many times the balloon was inflated and at what atmospheric pressures. This supports medical necessity and distinguishes the complexity of the dilation.
4. Esophageal segment treated. Identify the location of the stricture: proximal, mid, or distal esophagus, or the gastroesophageal junction. Payers cross-reference this against the diagnosis code.
5. Stricture characteristics. Document the estimated diameter of the stricture before dilation, the length of the narrowed segment, and the degree of luminal improvement after dilation.
6. Clinical indication and diagnosis. Link the dilation to a documented diagnosis such as peptic stricture, radiation stricture, anastomotic stricture, or eosinophilic esophagitis. The ICD-10 code must match what the note describes.
Why 43249 Claims Get Denied
Providers often come to us after a string of 43249 denials with no clear pattern. When we help them look at the claims, the same handful of errors appear repeatedly.
Missing balloon size: The note says a balloon dilation was performed but does not state the balloon diameter. Without the size, the payer cannot confirm whether 43249 or 43233 is correct, and the claim denies for insufficient documentation.
Billing 43235 alongside 43249: The diagnostic EGD is included in 43249. Reporting both triggers a bundling edit and the diagnostic code denies. Only report the therapeutic code when dilation is performed.
Wrong dilation code: Coding 43249 when the provider used a guidewire technique (which maps to 43248) or when the balloon was 30 mm or larger (which maps to 43233). The note and the code must match.
Diagnosis does not support dilation: Reporting 43249 with K21.9 (GERD without esophagitis) when the payer’s coverage policy requires a stricture diagnosis such as K22.2 (esophageal obstruction) or J95.89 (post-procedural complication) to cover dilation.
Missing modifier on same-session biopsy: Billing 43239 alongside 43249 without modifier 59 or XS, or without documentation supporting the biopsy as a separate service from a different indication.
In our experience matching GI practices with billing partners, the practices that clean up their 43249 documentation before submission rather than after a denial typically cut their dilation denial rate by more than half. The fix is not complex. It is a documentation checklist applied consistently to every EGD dilation note.
ICD-10 Codes That Pair With 43249
The diagnosis code linked to 43249 must support the medical necessity of esophageal dilation. These are the ICD-10-CM codes most commonly reported with 43249.
K22.2: Esophageal obstruction. The primary stricture code for benign esophageal narrowing.
K20.0: Eosinophilic esophagitis. Supports dilation when EoE causes esophageal narrowing or rings.
K22.1: Esophageal ulcer. Supports dilation when ulcerative disease has caused scarring and stricture.
Q39.3: Congenital stenosis and stricture of the esophagus. Supports dilation in pediatric or congenital cases.
K91.89: Other postprocedural complications and disorders of the digestive system. Covers anastomotic strictures following prior surgery.
T86.890: Other transplanted organ rejection. Supports dilation in esophageal stricture after transplant-related complications.
Pair the diagnosis to the documented cause of the stricture. A GERD-related peptic stricture maps to K22.2, not K21.9. Coding K21.9 alone for a dilation claim tells the payer that no stricture was found, which contradicts the reason for performing the procedure.
Frequently Asked Questions
What is CPT code 43249?
CPT 43249 is the procedure code for an esophagogastroduodenoscopy with transendoscopic balloon dilation of the esophagus using a balloon less than 30 mm in diameter. It is a therapeutic EGD code that includes the diagnostic component. The code is most commonly used for benign esophageal strictures.
What is the difference between CPT 43249 and 43233?
The difference is balloon size. CPT 43249 covers balloon dilation with a balloon under 30 mm. CPT 43233 covers balloon dilation with a balloon of 30 mm or larger. The operative note must specify the exact balloon diameter so the correct code can be assigned.
Can I bill 43235 and 43249 together?
No. CPT 43249 is a therapeutic EGD code that includes the diagnostic examination. Billing 43235 alongside 43249 triggers a bundling edit and the diagnostic code will deny. Only report the therapeutic code when balloon dilation is performed during the EGD.
Can I bill 43239 and 43249 on the same claim?
Yes, when documented correctly. CPT Assistant confirms that 43239 (EGD with biopsy) and 43249 can be reported together with modifier 59 or XS when the biopsy and the dilation are performed for separate clinical indications and the documentation supports both as distinct services.
What ICD-10 code supports 43249?
The most common diagnosis code is K22.2 (esophageal obstruction), which covers benign esophageal stricture. Other supporting codes include K20.0 for eosinophilic esophagitis, Q39.3 for congenital stenosis, and K91.89 for postprocedural complications such as anastomotic stricture.
How much does CPT 43249 reimburse under Medicare?
Under the CMS 2026 Physician Fee Schedule, CPT 43249 reimburses approximately $190 to $210 for the physician component, depending on geographic locality. Commercial payer reimbursement typically ranges from $250 to $500 for the physician component based on contracted rates.
Next Steps
For a closer look at how the 2027 Medicare payment changes affect GI endoscopy reimbursement, including the proposed 3% reduction, see our breakdown of the 2027 Medicare GI payment changes.
To learn more about how Gastroenterology Billing matches practices with vetted billing companies, visit our about us page.
Ready to stop losing EGD dilation revenue to documentation gaps and coding mismatches? Get matched with a billing company that specializes in GI.
Esophageal dilation claims carry enough revenue per case that a single coding error costs more than a month of billing fees. Gastroenterology Billing matches GI practices with vetted billing companies that code dilation correctly, stay current on NCCI edits, and catch documentation gaps before claims ship. Across all 50 states, with rates starting as low as 2.95%. Comparing quotes is 100% free for providers.
