CPT 43197 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
| CMS | $186.64 Physician Fee Schedule |
National average reimbursement for CPT 43197 by major payers:
$230.15
$256.26
$269.52
$333.14
| 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 43197 | ||||||
United | 43197 | $590.00 | 1356314249 - COLUMBIA ASC LLC, COLUMBIA GASTROINTESTINAL ENDOSCOPY CENTER | 621657449 - (SC) THE COLUMBIA ASC, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $400.00 | 1164734232 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 261545635 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $1233.00 | 1316508252 - MINIMALLY INVASIVE SURGICENTER LLC | 842130499 - (FL) MINIMALLY INVASIVE SURGICENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $2281.00 | 1982641890 - SUMMIT MEDICAL GROUP PA, SUMMIT MEDICAL GROUP AMBULATORY SURGERY CENTER | 223487984 - SUMMIT MEDICAL GROUP, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $708.00 | 1497011308 - BENJAMIN CHUNG MD INC, RIVERWALK SURGERY CENTER | 454738248 - (CA) BENJAMIN CHUNG MD INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $643.00 | 1811057029 - GREENSBORO NC ENDOSCOPY ASC LLC, GUILFORD ENDOSCOPY CENTER | 203802443 - (NC) GREENSBORO NC ENDOSCOPY ASC LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $460.00 | 1225414246 - LV SURGERY CENTER LLC | 473021380 - (NV) LV SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $1276.00 | 1366982845 - JACKSONVILLE ENDOSCOPY CENTERS LLC, JACKSONVILLE CENTER FOR ENDOSCOPY | 384016302 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $400.00 | 1477507168 - LAKESIDE SURGERY LLC, LAKESIDE SURGERY CENTER | 752714441 - LAKESIDE SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $326.39 | 1497381438 - BERNARD NDEDI | 350593390 - DEACONESS HOSPITAL INC | IL | Emergency Medicine Physician (207P00000X) |
United | 43197 | $795.00 | 1083000715 - CLEBURNE ENDOSCOPY CENTER, LLC | 471803806 - (TX) CLEBURNE ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $750.00 | 1871204511 - LAWRENCEVILLE CENTER FOR PAIN AND SPINE, LLC | 920689448 - (GA) LAWRENCEVILLE CENTER FOR PAIN AND SPINE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $957.00 | 1770075467 - DRY CREEK SURGERY CENTER, LLC | 825264853 - (CO) DRY CREEK SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $450.00 | 1710924881 - GEORGIA DERMASURGERY CENTERS, INC. | 582495671 - (GA) GEORGIA DERMASURGERY CENTERS INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43197 | $1846.00 | 1619333010 - ORANGE ASC, LTD, ORTHOPEDIC ONE SURGERY CENTER AT EASTON | 464700223 - (OH) ORANGE ASC LTD DBA ORTHOPEDIC ONE SURGERY CENTER AT EASTON | OH | 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 43197 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43197 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 43197 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 |
|---|---|---|
| 43197-CPT | Moderate | Esophagoscopy, Flexible, Transnasal; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed (Separate Procedure) |
| 43198-CPT | Moderate | Once Per Dos Esophagoscopy, Flexible, Transnasal; W/Biopsy, Single Or Multiple |
| 43200-CPT | Moderate | Esophagoscopy Flexible Transoral; Diagnostic Including Collection Of Specimen(S) By Brushing Orwashing When Performed (Separate Procedure) (Revised 01/01/2014) |
| 43202-CPT | Moderate | Esophagoscopy Flexible Transoral; With Biopsy Single Or Multiple (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43197. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43197 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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