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 |
| Medicare Fee Schedule | View Medicare rates for 43192 |
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 | $600.00 | 1972808186 - PALMETTO ENDOSCOPY SUITE, LLC | 272203762 - (SC) PALMETTO ENDOSCOPY SUITE LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $1749.00 | 1962626523 - CALLOWAY CREEK SURGERY CENTER LP | 141948102 - (TX) CALLOWAY CREEK SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $600.00 | 1568079788 - DIALYSIS ACCESS CENTER OF CINCINNATI, INC. | 815023998 - (OH) DIALYSIS ACCESS CENTER OF CINCINNATI INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $1367.00 | 1346289428 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE SURGEONS SEATTLE ORTHOPEDIC CENTER-ASC | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $1682.00 | 1023071560 - MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES, L.P., MEDICAL CITY SURGERY CENTER/FORT WORTH | 621489404 - (TX) MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $1666.00 | 1205875283 - RWJ ENDOSURGICAL CENTER LLC | 900872940 - (NJ) RWJ ENDOSURGICAL CENTER LLC | NJ | 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 | $750.00 | 1619557519 - SCOTTSDALE MULTISPECIALTY SURGERY CENTER, PARADISE VALLEY MULTI SPECIALTY SURGERY CENTER | 833515797 - (AZ) SCOTTSDALE MULTISPECIALTY SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $535.00 | 1154554160 - CABRILLO SURGERY CENTER | 270666008 - (CA) CABRILLO SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $555.00 | 1609568922 - BETHESDA ENDOSCOPY CENTER, LLC | 521915901 - (MD) BETHESDA ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $536.00 | 1053560896 - ASC DEVELOPMENT COMPANY, LLC, NATIONAL SPINE AND PAIN CENTERS | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $536.00 | 1326091513 - PAIN TREATMENT CENTERS OF MICHIGAN LLC, MATRIX SURGERY CENTER | 770623438 - (MI) PAIN TREATMENT CENTERS OF MICHIGAN LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $955.00 | 1255394771 - DOCTORS HOSPITAL SURGERY CENTER, L.P. | 861072579 - (GA) DOCTORS HOSPITAL SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $789.00 | 1447991138 - SILVER STATE SURGERY CENTER WEST LLC | 872764352 - (NV) SILVER STATE SURGERY CENTER WEST LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43192 | $480.00 | 1013513308 - JOHN KENYON AMERICAN EYE INSTITUTE LLC, EYE SURGERY CENTER OF ELIZABETHTOWN | 351907389 - JOHN-KENYON AMERICAN EYE INSTITUTE | KY | 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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