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See a sample rate comparisonCPT 43195 Fee Schedule
Last Verified: October 2026
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.
Esophagus Enlargement, Exam Of The Esophagus Aided By A Scope (Endoscope). The Procedure Inserts A Balloon That Is Inflated In Order To Enlarge Or Open Up The Esophagus.
| 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 | GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $159.32 national non-facility rate (2026) · View Medicare rates for 43195 |
| Medicaid Fee Schedule | $126.775 median of the 8 states in the free preview · View Medicaid rates for 43195 |
National average reimbursement for CPT 43195 by major payers:
$247.48
$252.06
$261.08
$316.07
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CPT 43195
5 of 25 sample ratesHigher to lower in this preview
West Orange Asc LLC, Gregori Surgery Center
West Orange Asc LLC
$3,157.00Published rateDigestivecare, LLC, Digestivecare Endoscopy Unit
Digestive Care, Inc.
$1,258.00Published rateRmc Surgery Center, LLC, Rmc Surgery Center
$862.00Published ratePacific Gastro Health PLLC, Pacific Gastro Health
Pacific Gastroenterology, PLLC
$650.00Published rateDigestive Health & Endoscopy Center LLC
$497.00Published rate
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See a sample payer proposalCPT 43195 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43195 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 43195 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 Trnso Dx, Esophagoscopy Rigid Transoral Diagnostic Including Collection Of Specimen S By Brushing Or Washing When Performed Separate Procedure |
| 43192-CPT | Moderate | Esophagoscopy Rigid Transoral; W/ Direct Submucosal Inject(S), Esophagoscopy Rigid Transoral; With Directed Submucosal Injection(S) |
| 43193-CPT | Moderate | Esophagus Exam With Scope, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy). |
| 43195-CPT | Moderate | Esophagus Enlargement, Exam Of The Esophagus Aided By A Scope (Endoscope). The Procedure Inserts A Balloon That Is Inflated In Order To Enlarge Or Open Up The Esophagus. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43195. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43195 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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