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See a sample rate comparisonCPT 43198 Fee Schedule
Last Verified: September 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 Exam With Scope, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy).
| 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 GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43198 |
| Medicaid Fee Schedule | View Medicaid rates for 43198 |
National average reimbursement for CPT 43198 by major payers:
$258.50
$284.09
$300.54
$191.78
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CPT 43198
5 of 25 sample ratesHigher to lower in this preview
Covenant Medical Center
$4,465.00Published rateSt Francis Hospital, Inc., St. Francis Eastside
St Francis Hospital Inc
$1,850.00Published rateCambize Shahrdar
Wk Orthopedic Clinic
$372.79Published rateGonzales Healthcare Systems, Memorial Hospital
$286.64Published rateKipp Cryar
Musculoskeletal Institute Inc. Florida Orthopaedic Institute
$105.41Published rate
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See a sample payer proposalCPT 43198 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43198 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 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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