CPT 43193 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 51 - Multiple procedures • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| CMS | $165.61 Physician Fee Schedule |
National average reimbursement for CPT 43193 by major payers:
$234.90
$238.45
$238.31
$300.37
| 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 43193 | ||||||
United | 43193 | $1276.00 | 1144954165 - ADVANCED SURGICAL CARE OF LUTZ, LLC, ADVANCED SURGICAL CARE OF NEW TAMPA | 871390521 - (FL) ADVANCED SURGICAL CARE OF LUTZ LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $2065.00 | 1689832438 - INOVA WOODBURN SURGERY CENTER LLC | 540620889 - INOVA HEALTH CARE SERVICES | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $1258.00 | 1891257473 - WESTGATE SURGERY CENTER, LLC, WESTGATE SURGERY CENTER | 352651945 - (AZ) WESTGATE SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $1298.00 | 1053835058 - CEI PHYSICIANS PSC LLC, CVP SURGERY CENTER | 311473421 - CINCINNATI EYE INSTITUTE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $2954.00 | 1841234150 - HINSDALE SURGICAL CENTER, LLC | 362276984 - ADVENTIST MIDWEST HEALTH | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $947.00 | 1144333881 - NORTH SCOTTSDALE AMBULATORY SURGERY CENTER, LLC | 200554616 - (AZ) NORTH SCOTTSDALE AMBULATORY SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $373.00 | 1124296173 - TREASURE COAST SURGICAL CENTER INC | 260770428 - (FL) TREASURE COAST SURGICAL CENTER, INC. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $750.00 | 1407023161 - SOUTHWEST MINNESOTA SURGICAL CENTER, INC. | 261451498 - (MN) SOUTHWEST MINNESOTA SURGICAL CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $478.00 | 1780661967 - CJ ELMWOOD PARTNERS L P | 911793912 - CJ ELMWOOD PARTNERS L P | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $846.00 | 1376885400 - MD ANAHEIM SURGERY CENTER INC | 462311690 - (CA) MD ANAHEIM SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $1220.00 | 1023551413 - MID-BRONX ENDOSCOPY CENTER LLC | 471156630 - (NY) MIDBRONX ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $4618.00 | 1609876556 - PEAK ONE SURGERY CENTER, LLC, PEAK ONE SURGERY CENTER | 201620230 - (CO) PEAK ONE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $750.00 | 1194712109 - EXECUTIVE ENDOSCOPY, INC, ENDOSCOPY CENTER OF SAN JOSE | 770583401 - (CA) EXECUTIVE ENDOSCOPY INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $3908.00 | 1881678662 - SURGERY AFFILIATE OF EL PASO, LLC, FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC | 742797719 - (TX) SURGERY AFFILIATE OF EL PASO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43193 | $464.00 | 1619124401 - CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | 562059693 - (NC) CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | NC | 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 43193 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43193 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 43193 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 43193. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43193 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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