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See a sample rate comparisonCPT 43200 Fee Schedule
Medicare rates as of October 2026
CPT 43200 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Esophagoscopy Flexible Brush, Esophagoscopy Flexible Transoral Diagnostic Including Collection Of Specimen S By Brushing Or Washing When Performed Separate Procedure
| 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 | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $286.91 national non-facility rate (2026) · View Medicare rates for 43200 |
| Medicaid Fee Schedule | $225.42 median of the 8 states in the free preview · View Medicaid rates for 43200 |
National average reimbursement for CPT 43200 by major payers:
$304.25
BCBS / Anthem
$314.43
UnitedHealthcare
$363.36
Aetna
$165.94
Cigna
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CPT 43200
5 of 25 sample ratesHigher to lower in this preview
San Antonio Surgery Center, The Center For Special Surgery @ Tca
$3,008.00Published rateMid-State Endoscopy Center LLC
Midstate Endoscopy Center LLC
$1,258.00Published rateLorain Surgery Center, LLC
Lorain Surgery Center LLC
$700.00Published rateApex Ambulatory Surgery Center Inc
$580.00Published rateFour Corners Ambulatory Surgical Center LLC
$197.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 43200 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43200. Select one to see its fee schedule.
| 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 |
| 43201-CPT | Moderate | Esophagus Exam With Scope, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure May Include An Injection Of A Substance. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43200. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43200 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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