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 |
| Medicare Fee Schedule | View Medicare rates for 43205 |
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 | $2807.00 | 1659335438 - RESTON SURGERY CENTER, LP | 113654617 - (VA) RESTON SURGERY CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $609.00 | 1437274495 - EYE SURGICAL CENTER OF SAN FRANCISCO LLC, EYE SURGERY CENTER OF SAN FRANCISCO | 203822864 - (CA) EYE SURGERY CENTER OF SAN FRANCISCO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1196.00 | 1609815075 - ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE, LLC | 202961633 - (GA) ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $799.00 | 1730687179 - MULTICARE HEALTH SYSTEM, MULTICARE ROCKWOOD EYE SURGERY CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1367.00 | 1194727883 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE PUGET SOUND SURGERY CENTER | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $228.00 | 1386885556 - THE ASC AT WAUGH CHAPEL | 263869837 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $753.50 | 1245471788 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $117.02 | 1225421886 - ASHTIN COLLINS | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
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 | $2392.00 | 1508367194 - TEXAS HEALTH ORTHOPEDIC SURGERY CENTER ALLIANCE, LLC, TEXAS HEALTH ORTHOPEDIC SURGERY CENTER HERITAGE | 814977249 - (TX) TEXAS HEALTH ORTHOPEDIC SURGERY CENTER ALLIANCE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1358.00 | 1891717195 - CENTER FOR PAIN MANAGEMENT LLC, TUCSON UROLOGIC SURGERY CENTER | 830962530 - (AZ) CENTER FOR PAIN MANAGEMENT LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $538.00 | 1508531740 - BAY AREA HEART SURGERY CENTER | 852782496 - (FL) BAY AREA HEART SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43205 | $1528.00 | 1679504690 - SANTA CLARITA SURGERY CENTER LP | 202829660 - (CA) SANTA CLARITA SURGERY CENTER LP | CA | 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 | $753.50 | 1255314662 - MAZZOCCO AMBULATORY SURGICAL CENTER | 954505995 - (CA) MAZZOCCO AMBULATORY SURGICAL CENTER | CA | 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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