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See a sample rate comparisonCPT 43206 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/ Optical Endomicroscopy, Esophagoscopy Flexible Transoral; With Optical Endomicroscopy
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | 51 - Multiple procedures 80 - Assistant surgeon None |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43206 |
| Medicaid Fee Schedule | View Medicaid rates for 43206 |
National average reimbursement for CPT 43206 by major payers:
$546.86
$410.51
$408.76
$261.05
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CPT 43206
5 of 25 sample ratesHigher to lower in this preview
Ambulatory Surgery Center Group Ltd
$5,532.00Published rateMonocacy Surgery Center LLC
Monocacy Surgery Center
$1,276.00Published rateMays & Schnapp Pain Clinic & Rehabilitation Center
Mays Schnapp Pain Clinic Rehabilitation Center
$699.00Published rateArkansas Otolaryngology Center, P.A., Aoc Surgery Center, Inc
Arkansas Otolaryngology Center, P.A.
$490.00Published rateOsaze Edo-Ohonba
Deaconess Hospital Inc
$221.71Published rate
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See a sample payer proposalCPT 43206 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43206 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 43206 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 |
|---|---|---|
| 43197-CPT | Moderate | Esophagoscopy Flex Dx Brush, Esophagoscopy Flexible Transnasal Diagnostic Including Collection Of Specimen S By Brushing Or Washing When Performed Separate Procedure |
| 43198-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 |
| 43206-CPT | Moderate | Esophagoscopy Flex Transoral; W/ Optical Endomicroscopy, Esophagoscopy Flexible Transoral; With Optical Endomicroscopy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43206. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43206 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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