CPT 43204 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 | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43204 |
National average reimbursement for CPT 43204 by major payers:
$221.97
$221.37
$208.83
$252.44
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 43204 | $658.00 | 1629135843 - NAEEM M AKHTAR, MADERA AMBULATORY ENDOSCOPY CENTER | 770194609 - (CA) NAEEM M. AKHTAR, M.D. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $580.00 | 1750609731 - BELTLINE SURGERY CENTER, LLC | 262639054 - (TX) BELTLINE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $580.00 | 1346624665 - WESTGREEN SURGICAL CENTER LLC, HOUSTON ORTHOPEDIC & SPINE SURGERY CENTER | 474468184 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $1500.00 | 1205171295 - VANCE THOMPSON VISION SURGERY CENTER PROF LLC, VANCE THOMPSON VISION SURGERY CENTER | 843362063 | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $773.00 | 1619576824 - SURGICARE OF LA VETA, LTD., NEWPORT COAST SURGICAL INSTITUTE | 752507129 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $1258.00 | 1902302961 - HILL COUNTRY SURGERY CENTER, LLC, SURGERY CENTER OF BOERNE | 352599588 - (TX) HILL COUNTRY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $800.00 | 1033154851 - PARKWEST SURGERY CENTER LP | 621808841 - (TN) PARKWEST SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $753.50 | 1861930729 - FRESNO SPECIALTY SURGERY CENTER PC | 814226298 - (CA) FRESNO SPECIALTY SURGERY CENTER PC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $543.00 | 1447661145 - ADVANCED OUTPATIENT SURGERY OF OKLAHOMA, LLC | 371751472 - (OK) ADVANCED OUTPATIENT SURGERY OF | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $487.00 | 1730169657 - LEO R. MCCAFFERTY, M.D., SURGICAL CENTER | 200421646 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $1179.00 | 1558879684 - DELAWARE RIVER SURGICAL SUITES, LLC | 822713553 - (PA) BUCKS COUNTY SURGICAL SUITES | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $1258.00 | 1811001860 - THE OUTPATIENT CENTER, LLC, THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | 650440864 - (FL) THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $471.00 | 1417994831 - CATALINA SURGERY CENTER, LLC | 201680197 - (AZ) CATALINA SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $1250.00 | 1821036534 - PARKWAY SURGERY CENTER, LLC | 204127100 - (MD) PARKWAY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43204 | $941.00 | 1003870825 - PINELLAS SURGERY CENTER, LLC, CENTER FOR SPECIAL SURGERY | 752563226 - (FL) PINELLAS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 43204 vs. Other Endoscopy Procedures on the Esophagus Codes
The CPT 43204 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 43204 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 |
|---|---|---|
| 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 |
| 43205-CPT | Moderate | Esophagoscopy Flex Transoral; W/ Bnd Ligati Of Esophageal V, Esophagoscopy Flexible Transoral; With Band Ligation Of Esophageal V |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43204. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43204 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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