CPT 43205 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 | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| CMS | $134.89 Physician Fee Schedule |
National average reimbursement for CPT 43205 by major payers:
$227.63
$226.57
$222.74
$264.33
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 43205 | ||||||
United | 43205 | $993.00 | 1578003208 - MINNESOTA EYE LASER & SURGERY CENTERS, LLC | 460505033 - (MN) MINNESOTA EYE LASER SURGERY CENTERS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $254.71 | 1063827525 - ROBERT MURRAY | 350593390 - DEACONESS HOSPITAL INC | KY | Sleep Medicine (Family Medicine) Physician (207QS1201X) |
United | 43205 | $1585.00 | 1346249604 - ST. MARY'S SURGICAL CENTER LLC, ST. MARY'S SURGICAL CENTER | 201685516 - (MO) ST MARYS SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1528.00 | 1841605318 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER, LLC, FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER-CITRUS PARK | 593646134 - (FL) FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $2807.00 | 1659335438 - RESTON SURGERY CENTER, LP | 113654617 - (VA) RESTON SURGERY CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1154.00 | 1174588206 - CHARLESTON SURGERY CENTER LIMITED PARTNERSHIP | 581709761 - (SC) CHARLESTON SURGERY CENTER LIMITED PARTNERSHIP | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1183.00 | 1831109560 - NEW MEXICO ORTHOPAEDIC SURGERY CENTER, LLC, NEW MEXICO SURGERY CENTER ORTHOPAEDICS | 621797896 | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1179.00 | 1356307565 - AMBULATORY SURGICAL ASSOCIATES LLC, TULLAHOMA SURGERY CENTER | 61658016 - (TN) AMBULATORY SURGICAL ASSOCIATES LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1276.00 | 1730318353 - GARDENDALE SURGICAL ASSOCIATES, LLC | 205936644 - (AL) GARDENDALE SURGICAL ASSOCIATES | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $614.00 | 1275184293 - JOHNS HOPKINS SURGERY CENTERS SERIES, BEL AIR SURGERY CENTER | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1050.00 | 1073944039 - THE POLYCLINIC, THE POLYCLINIC PLASTIC SURGERY CENTER | 910369070 - (WA) THE POLYCLINIC, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $461.00 | 1750597449 - OKLAHOMA LITHOTRIPTER ASSOCIATES, L.C., OKLAHOMA KIDNEY STONE CENTER | 731415771 - (OK) OKLAHOMA LITHOTRIPTER ASSOCIATES, LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $513.00 | 1184948663 - ASSOCIATED UROLOGISTS AMBULATORY SURGERY CENTER LLC | 272200221 - (KS) ASSOCIATED UROLOGISTS AMBULATORY SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $524.00 | 1760414056 - VAN DYCK ASC, LLC | 621817203 - (TN) VAN DYCK ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $803.00 | 1568963189 - BAPTIST SURGERY AND ENDOSCOPY CENTERS, LLC, BAPTIST HEALTH ENDOSCOPY CENTER AT MIAMI BEACH | 201796841 | 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 43205 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43205 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 43205 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 | Esophagoscopy Flexible Transoral; With Directed Submucosal Injection(S) Any Substance (Revised 01/01/2014) |
| 43202-CPT | Moderate | Esophagoscopy Flexible Transoral; With Biopsy Single Or Multiple (Revised 01/01/2014) |
| 43204-CPT | Moderate | Esophagoscopy Flexible Transoral; With Injectionsclerosis Of Esophageal Varices (Revised 01/01/2014) |
| 43205-CPT | Moderate | Esophagoscopy Flexible Transoral; With Band Ligation Of Esophageal Varices (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43205 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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