CPT 43198 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 | Esophagoscopy Procedures Endoscopy Procedures on the Esophagus |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43198 |
National average reimbursement for CPT 43198 by major payers:
$258.50
$284.09
$300.54
$191.78
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 43198 | $335.70 | 1447707583 - MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC | 721310991 - (LA) MIDSTATE ORTHOPAEDIC & SPORTS MEDICINE CENTER, INC. | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43198 | $2991.00 | 1497796296 - ST FRANCIS HOSPITAL INC, ST. FRANCIS EASTSIDE | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 43198 | $2664.00 | 1972640316 - BAYLOR ALL SAINTS MEDICAL CENTER | 751008430 - (TX) BAYLOR ALL SAINTS MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 43198 | $239.25 | 1740226802 - RODERICK CHANDLER | 721387869 - (LA) PAUL VAN DEVENTER M.D. | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43198 | $868.00 | 1972581940 - THE COMMUNITY HOSPITAL OF BRAZOSPORT, BRAZOSPORT MEMORIAL HOSPITAL &BRAZOSPORT REGIONAL HEALTH SYSTEM | 741385192 - (TX) COMMUNITY HOSPITAL OF BRAZOSPORT | TX | General Acute Care Hospital (282N00000X) |
United | 43198 | $201.41 | 1942231865 - GEORGE WILLIAMS | 200027279 - (LA) GEORGE RAYMOND WILLIAMS, M.D. ORTHOPAEDIC SURGERY, | LA | Orthopaedic Surgery of the Spine Physician (207XS0117X) |
United | 43198 | $1276.00 | 1437419660 - ADVANCED SURGERY CENTER OF METAIRIE LLC | 453386956 - (LA) ADVANCED SURGERY CENTER OF METAIRIE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43198 | $286.64 | 1508859612 - GONZALES HEALTHCARE SYSTEMS, MEMORIAL HOSPITAL | 741625013 | TX | General Acute Care Hospital (282N00000X) |
United | 43198 | $105.41 | 1982023727 - KIPP CRYAR | 592929608 - (FL) MUSCULOSKELETAL INSTITUTE INC. FLORIDA ORTHOPAEDIC INSTITUTE | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43198 | $2884.00 | 1558305995 - ST. FRANCIS HOSPITAL, INC., ST. FRANCIS DOWNTOWN | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 43198 | $230.38 | 1821049743 - DAVID ELIAS | 726008504 - (LA) HOSPITAL SERVICE DISTRICT NO 1 OF THE PARISH OF ST MARY | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43198 | $353.48 | 1033167325 - MICHAEL ROBICHAUX | 721460193 - (LA) BATON ROUGE ORTHOPAEDIC CLINIC, LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43198 | $1721.00 | 1407903586 - LUBBOCK HEART HOSPITAL | 510436196 - (TX) LUBBOCK HEART HOSPITAL, LP | TX | General Acute Care Hospital (282N00000X) |
United | 43198 | $4465.00 | 1972517365 - COVENANT MEDICAL CENTER | 822913146 - (TX) COVENANT MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 43198 | $321.75 | 1548230048 - PETER VIZZI | 200736590 - (LA) PETER D VIZZI MD AMC | LA | Orthopaedic Surgery Physician (207X00000X) |
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 43198 vs. Other Endoscopy Procedures on the Esophagus Codes
The CPT 43198 code is part of the Esophagoscopy Procedures services used for Endoscopy Procedures on the Esophagus. 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 43198 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 Flex Dx Brush, Esophagoscopy Flexible Transnasal Diagnostic Including Collection Of Specimen S By Brushing Or Washing When Performed Separate Procedure |
| 43198-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). |
| 43200-CPT | Moderate | Esophagoscopy Flexible Brush, Esophagoscopy Flexible Transoral Diagnostic Including Collection Of Specimen S By Brushing Or Washing When Performed Separate Procedure |
| 43206-CPT | Moderate | Esophagoscopy Flex Transoral; W/ Optical Endomicroscopy, Esophagoscopy Flexible Transoral; With Optical Endomicroscopy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43198. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43198 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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