CPT 43206 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 | • 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 |
National average reimbursement for CPT 43206 by major payers:
$546.86
$410.51
$408.76
$542.00
| 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 43206 | ||||||
United | 43206 | $221.71 | 1639331317 - OSAZE EDO-OHONBA | 350593390 - DEACONESS HOSPITAL INC | MO | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | 43206 | $1850.00 | 1033668587 - LANCASTER SPECIALTY SURGERY CENTER | 812461923 - (OH) LANCASTER SPECIALTY SURGICAL CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $2209.00 | 1578558763 - HUNT MEMORIAL HOSPITAL DISTRICT, HUNT REGIONAL HEALTHCARE | 751277293 - (TX) HUNT MEMORIAL HOSPITAL DISTRICT | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $850.00 | 1063838357 - METROEAST ENDOSCOPIC SURGERY CENTER | 461844105 - (IL) METROEAST ENDOSCOPIC SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $482.54 | 1831693076 - SUNDEEP MUMMANENI | 350593390 - DEACONESS HOSPITAL INC | GA | Internal Medicine Physician (207R00000X) |
United | 43206 | $437.00 | 1528307188 - SGFC SURGERY CENTER, LLC, SGFC SURGERY CENTER | 208131466 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $1233.00 | 1134431323 - BETHESDA CHEVY CHASE SURGERY CENTER, LLC | 272875760 - (MD) BETHESDA CHEVY CHASE SURGERY CEN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $5532.00 | 1629032446 - AMBULATORY SURGERY CENTER GROUP LTD | 592073099 - (FL) AMBULATORY SURGERY CENTER GROUP LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $1509.00 | 1366406233 - MIDDLE TENNESSEE AMBULATORY SURGERY CENTER, L.P. | 621699667 - (TN) MIDDLE TENNESSEE AMBULATORY SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $692.00 | 1558926931 - WELLNESS AMBULATORY SURGERY CENTER, LLC | 810848308 - (TX) WELLNESS AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $840.00 | 1538549852 - BAKERSFIELD SPECIALISTS SURGICAL CENTER, LLC | 465765998 - (CA) BAKERSFIELD SPECIALISTS SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $2480.00 | 1508837899 - MEMORIAL HERMANN SURGERY CENTER NORTHWEST, LLP, MEMORIAL HERMANN SURGERY CENTER GREATER HEIGHTS | 200689650 - (TX) MEMORIAL HERMANN SURGERY CENTER NORTHWEST LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $421.00 | 1114177417 - NISENFELD & CHILTON, MD PA, ORTHOPAEDIC ASSOCIATES OF FREDERICK, ASC | 521135399 - (MD) NISENFELD & CHILTON, M.D., P.A. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $1630.00 | 1871895821 - GWINNETT SURGERY CENTER, LLC | 272819709 - (GA) GWINNETT SURGERY CENTER,LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43206 | $699.00 | 1023182581 - MAYS & SCHNAPP PAIN CLINIC & REHABILITATION CENTER | 621512849 - (TN) MAYS SCHNAPP PAIN CLINIC REHABILITATION CENTER | TN | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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, Flexible, Transnasal; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed (Separate Procedure) |
| 43198-CPT | Moderate | Once Per Dos Esophagoscopy, Flexible, Transnasal; W/Biopsy, Single Or Multiple |
| 43204-CPT | Moderate | Esophagoscopy Flexible Transoral; With Injectionsclerosis Of Esophageal Varices (Revised 01/01/2014) |
| 43206-CPT | Moderate | Esophagoscopy Flexible Transoral; With Optical Endomicroscopy (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 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43206) and we'll show you how you compare in 15 minutes or less.