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See a sample rate comparisonCPT 43201 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 An Injection Of A Substance.
| 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 | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43201 |
| Medicaid Fee Schedule | View Medicaid rates for 43201 |
National average reimbursement for CPT 43201 by major payers:
$338.49
$342.15
$372.19
$192.15
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CPT 43201
5 of 25 sample ratesHigher to lower in this preview
Ssm St Clare Surgical Center LLC, Ssm St Clare Surgical Center
Ssm St Clare Surgical Center LLC
$2,269.00Published rateHouston Urologic Surgicenter, LLC
$1,299.00Published rateGenesee Care L.L.C., The Surgery Center Of Genesee County
Genesee Care LLC
$1,200.00Published rateRuxton Surgicenter LLC
$577.00Published rateSarah Kung
Deaconess Hospital Inc
$401.61Published rate
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See a sample payer proposalCPT 43201 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43201 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 43201 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 |
|---|---|---|
| 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. |
| 43202-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). |
| 43204-CPT | Moderate | Esophagoscopy Flex Transoral; W/ Inject Sclerosis Of Esopha, Esophagoscopy Flexible Transoral; With Injection Sclerosis Of Esopha |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43201. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43201 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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