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See a sample rate comparisonCPT 43205 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.
Esophagoscopy Flex Transoral; W/ Bnd Ligati Of Esophageal V, Esophagoscopy Flexible Transoral; With Band Ligation Of Esophageal V
| 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 |
| Medicare Fee Schedule | View Medicare rates for 43205 |
| Medicaid Fee Schedule | View Medicaid rates for 43205 |
National average reimbursement for CPT 43205 by major payers:
$227.63
$226.57
$222.74
$259.24
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CPT 43205
5 of 25 sample ratesHigher to lower in this preview
Reston Surgery Center, Lp
Reston Surgery Center Lp
$2,807.00Published rateCenter For Pain Management LLC, Tucson Urologic Surgery Center
Center For Pain Management LLC
$1,358.00Published rateMinnesota Eye Laser & Surgery Centers, LLC
Minnesota Eye Laser Surgery Centers LLC
$993.00Published rateBay Area Heart Surgery Center
$538.00Published rateAshtin Collins
Deaconess Hospital Inc
$117.02Published rate
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See a sample payer proposalCPT 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 | 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 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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