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See a sample rate comparisonCPT 43202 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 | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43202 |
| Medicaid Fee Schedule | View Medicaid rates for 43202 |
National average reimbursement for CPT 43202 by major payers:
$400.89
$425.10
$490.15
$194.30
Compare published rates across providers.
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CPT 43202
5 of 25 sample ratesHigher to lower in this preview
New Jersey Surgery Center LLC, New Jersey Surgery Center
New Jersey Surgery Center LLC
$2,064.00Published rateVesc LLC, Adventhealth Surgery Center Ormond Beach
Vesc LLC
$1,190.00Published rateMississippi Coast Endoscopy & Ambulatory Center LLC, Mississippi Coast Endoscopy & Ambulatory Surgical
Mississippi Coast Endoscopy And Ambulatory Center, LLC
$620.00Published rateNirmal Joshi
Deaconess Hospital Inc
$561.53Published rateMeredith Schmitt
Deaconess Hospital Inc
$258.00Published rate
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See a sample payer proposalCPT 43202 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43202 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 43202 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 43202. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43202 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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