How much does Medicare pay for CPT 43450?

Medicare allowed an average of $165.67 per service and paid $131.97 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $917.05, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43450?

Dilation of esophagus. It was billed 71,630 times to 69,168 Medicare beneficiaries by 1,551 providers in 2024.

Does 43450 pay differently in an office than a hospital?

Yes. The allowed amount averaged $66.09 in an office setting and $167.08 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 43450 most?

Gastroenterology, with 40,489 services from 1,044 clinicians. Next are Ambulatory Surgical Center, Internal Medicine, General Surgery.

CPT 43450

Dilation of esophagus

$165.67Medicare-allowed amount per service, averaged across 71,630 services

Providers submitted

$917.05

Asking price, not received

Medicare allowed

$165.67

The fee schedule figure

Medicare paid

$131.97

Balance is patient coinsurance

Providers submitted an average of $917.05 for this code and Medicare allowed $165.67 — 5.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $131.97 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $66.09
Hospital / facility: $167.08

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,004 services were billed in an office setting and 70,626 in a facility.

Services: 71,630
Beneficiaries: 69,168
Providers billing it: 1,551
Total allowed: $11,866,942

What Medicare pays for CPT 43450

Across 71,630 services billed by 1,551 providers to 69,168 beneficiaries, Medicare allowed an average of $165.67 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 43450

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	40,489	39,023	$38.50	1,044
Ambulatory Surgical Center	27,473	26,624	$370.13	382
Internal Medicine	2,146	2,073	$37.98	61
General Surgery	1,190	1,147	$37.50	51
Otolaryngology	133	118	$41.38	7
Emergency Medicine	109	108	$36.08	2
Plastic and Reconstructive Surgery	47	35	$40.48	1
Osteopathic Manipulative Medicine	15	14	$36.24	1
Anesthesiology	15	13	$37.14	1
Colorectal Surgery (Proctology)	13	13	$36.32	1

43450 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
South Carolina	7,327	$182.86	$158.88	78
Florida	5,719	$173.00	$148.40	140
Tennessee	5,639	$161.07	$144.47	90
Louisiana	4,399	$167.91	$150.79	59
North Carolina	4,331	$169.02	$143.34	105
Ohio	4,166	$174.08	$150.34	93
Texas	3,922	$161.21	$136.19	104
Pennsylvania	2,824	$205.21	$171.92	89
Michigan	2,713	$176.69	$147.44	65
California	2,699	$232.12	$162.53	65
Mississippi	2,563	$139.02	$133.23	33
Indiana	2,246	$107.27	$89.12	47
Georgia	2,088	$185.86	$155.51	59
Kansas	1,860	$131.03	$112.50	39
Missouri	1,741	$151.87	$128.36	42
Alabama	1,624	$120.84	$115.06	21
Arkansas	1,393	$108.59	$94.77	28
Virginia	1,290	$77.32	$61.81	42
Nebraska	1,226	$172.59	$142.34	34
Kentucky	1,125	$133.47	$116.61	23
Oklahoma	1,110	$154.42	$133.95	19
Utah	1,088	$169.94	$142.34	22
New Jersey	1,048	$211.37	$163.10	32
New York	1,026	$169.34	$132.84	28
Illinois	999	$123.83	$102.16	24
Arizona	949	$193.73	$157.84	24
Maryland	873	$239.03	$193.33	24
Colorado	603	$200.26	$159.97	18
Massachusetts	425	$121.88	$90.78	13
West Virginia	417	$39.73	$33.36	11
Wisconsin	293	$105.17	$88.99	13
Delaware	284	$191.11	$151.93	9
Nevada	273	$259.43	$199.07	9
Iowa	250	$201.86	$172.36	7
Minnesota	183	$227.17	$179.43	6
Idaho	179	$173.93	$151.28	5
Connecticut	137	$70.43	$52.71	9
South Dakota	121	$89.10	$76.68	4
Oregon	106	$150.81	$109.55	6
New Mexico	86	$216.34	$167.84	2
Rhode Island	77	$167.86	$139.20	2
North Dakota	62	$37.61	$29.85	1
Montana	61	$38.37	$28.11	2
Maine	31	$39.27	$30.04	2
Washington	30	$38.31	$29.83	2
New Hampshire	24	$98.50	$73.84	1

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.