CPT 43192 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 52 - Reduced Services • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $165.29 Physician Fee Schedule |
National average reimbursement for CPT 43192 by major payers:
$233.29
$224.55
$235.10
$291.15
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 43192 | ||||||
United | 43192 | $2706.48 | 1124022595 - THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS, LLC, SURGERY CENTER CEDAR RAPIDS | 721550812 - (IA) THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $640.00 | 1396719563 - BAPTIST GERMANTOWN SURGERY CENTER, LLC, BAPTIST GERMANTOWN SURGERY CENTER | 621829424 - (TN) BAPTIST GERMANTOWN SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $400.00 | 1538242649 - SOUTHWESTERN ENDOSCOPY CENTER, LLC | 571139709 - (PA) SOUTHWESTERN ENDOSCOPY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $587.00 | 1699817346 - CASCADE EYE & SKIN CENTERS PC, CASCADE LASER & SURGERY CENTER | 911525215 - (WA) CASCADE EYE AND SKIN CENTERS, P.C. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $1233.00 | 1285815522 - TLC ASC, LLC, KZMSS AGAIN, LLLP | 201952603 - (FL) TLC ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $1128.00 | 1447457403 - BERGEN GASTROENTEROLOGY PC | 222713168 - (NJ) BERGEN GASTROENTEROLOGY, P.C. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $997.00 | 1508135658 - SURGERY CENTER OF ATHENS LLC | 450581955 - (GA) SURGERY CENTER OF ATHENS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $477.00 | 1174716708 - HENDERSON SURGERY CENTER | 208615920 - (NV) HENDERSON SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $598.00 | 1023153160 - INNOVIA SURGERY CENTER, LLC, ADVANTAGE HEALTHCARE | 364167589 - (IL) INNOVIA SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $360.00 | 1497895676 - DEKALB GASTROENTEROLOGY ASSOCIATES III, LLC, DEKALB ENDOSCOPY CENTER | 582316075 - (GA) DEKALB GASTROENTEROLOGY ASSOCIATES III LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $750.00 | 1407095359 - PAIN CARE CENTER OF GEORGIA LLC | 814348805 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $1854.00 | 1437116274 - SILVER SPRINGS SURGERY CENTER LLC | 431804124 - (MO) SILVER SPRINGS SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $468.00 | 1386641066 - EYE SURGERY CENTER OF MARYVILLE LLC, EYES OF ILLINOIS SURGERY CENTER | 364111317 - (IL) NOVAMED EYE SURGERY CENTER OF MARYVILLE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $1179.00 | 1487716650 - CARONDELET ST. MARY'S NORTHWEST, LLC, CARONDELET FOOTHILLS SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $1229.00 | 1265486849 - FEATHERSTONE PARTNERSHIP LP, ROCKFORD AMBULATORY SURGERY CENTER | 363861021 - (IL) THE FEATHERSTONE PARTNERSHIP L. P. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 43192 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43192 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 43192 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 43191-CPT | Moderate | Esophagoscopy, Rigid, Transoral; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing When Performed (Separate Procedure) |
| 43192-CPT | Moderate | Once Per Dos Esophagoscopy, Rigid, Transoral; W/Directed Submucosal Injection(S), Any Substance |
| 43193-CPT | Moderate | Once Per Dos Esophagoscopy, Rigid, Transoral; W/Biopsy, Single Or Multiple |
| 43194-CPT | Moderate | Esophagoscopy Rigid Transoral; With Removal Of Foreign Body(S) (Desc Revised 01/01/15) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43192. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43192 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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