CPT 43194 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43194 |
National average reimbursement for CPT 43194 by major payers:
$247.08
$251.69
$263.52
$322.15
| 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 43194 | ||||||
United | 43194 | $520.00 | 1366496143 - VIRGINIA SURGERY CENTER, LLC, CVP SURGERY CENTER | 541922041 - (VA) VIRGINIA SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $799.00 | 1730687179 - MULTICARE HEALTH SYSTEM, MULTICARE ROCKWOOD EYE SURGERY CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $435.00 | 1588839609 - RIVERWALK AMBULATORY SURGERY CENTER LLC | 260594903 - (FL) RIVERWALK AMBULATORY SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $1838.00 | 1447269790 - WEST BEND SURGERY CENTER LLC | 391954169 - (WI) WEST BEND SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $555.00 | 1053711275 - ASC LONE TREE LLC, ICON SURGERY CENTER OF DENVER | 471652599 - (CO) ASC LONE TREE LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $970.00 | 1215245238 - AMERICAN ACCESS CARE OF NEW JERSEY, LLC, AZURA SURGERY CENTER CHERRY HILL | 223783657 - (NJ) AMERICAN ACCESS CARE OF NEW JERSEY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $1276.00 | 1447362769 - BETHLEHEM ENDOSCOPY CENTER LLC | 233032591 - (PA) BETHLEHEM ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $2282.00 | 1649931072 - MEDICAL CITY SPECIALTY SURGICENTER OF DALLAS, LLC, MEDICAL CITY ORTHOPEDIC & SPINE SURGERY CENTER DALLAS | 842824507 - (TX) MEDICAL CITY SPECIALTY SURGICENTER OF DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $743.00 | 1093705774 - SURGICENTER OF MANSFIELD, LTD. | 311515255 - (OH) SURGICENTER OF MANSFIELD, LTD. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $766.00 | 1134140122 - ARTHROSCOPIC SURGERY CENTER, LLC | 392000854 - (WI) ARTHROSCOPIC SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $715.00 | 1033181862 - EL PASO ASC LP, ENDOSCOPY CENTER OF EL PASO | 621731682 - (TX) EL PASO ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $28000.00 | 1720127483 - FRONT RANGE ORTHOPEDIC SURGERY CENTER LLC | 311728173 - (CO) FRONT RANGE ORTHOPEDIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $2050.00 | 1598417875 - ESSENTIA HEALTH SURGERY CENTERS-DULUTH LLC, ESSENTIA HEALTH SURGERY CENTER-MILLER HILL | 874339770 - (MN) ESSENTIA HEALTH SURGERY CENTERSDULUTH LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $2701.00 | 1336538297 - MINNETONKA AMBULATORY SURGERY CENTER LLC | 465653486 - (MN) MINNETONKA AMBULATORY SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43194 | $775.00 | 1679595680 - SURGERY CENTER OF LEBANON, LP, PHYSICIANS SURGICAL CENTER | 721588584 - (PA) SURGERY CENTER OF LEBANON LP | PA | 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 43194 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43194 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 43194 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 43194. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43194 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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