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See a sample rate comparisonCPT 43210 Fee Schedule
Medicare rates as of October 2026
CPT 43210 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Scope Exam Of Stomach, Examination Of The Esophagus Stomach And Small Intestine Using A Scope (Endoscope). The Procedure Includes Tightening The Junction Between The Esophagus And The Stomach.
| 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 | 62 - Co-Surgeons UB |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $379.43 national non-facility rate (2026) · View Medicare rates for 43210 |
| Medicaid Fee Schedule | $301.54 median of the 8 states in the free preview · View Medicaid rates for 43210 |
National average reimbursement for CPT 43210 by major payers:
$575.35
BCBS / Anthem
$597.74
UnitedHealthcare
$601.96
Aetna
$704.32
Cigna
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CPT 43210
5 of 25 sample ratesHigher to lower in this preview
St Vincent Hospital-Hospital Sisters-Third Order Of St Francis, Prevea Surgery Center
St Vincent Hospital-Hospital Sisters-Third Order Of St Francis
$5,859.00Published rateCapital Endoscopy LLC
Capital Endoscopy & Surgery Center
$3,124.00Published rateValley Surgical Center Ltd, Valley Surgery Center
Valley Surgical Center Ltd
$1,984.00Published rateEye Surgery And Laser Clinic, Inc.
Eye Surgery And Laser Clinic Inc
$1,522.00Published ratePalmetto Endoscopy Center
$614.00Published rate
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See a sample payer proposalCPT 43210 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43210. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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 |
| 43206-CPT | Moderate | Esophagoscopy Flex Transoral; W/ Optical Endomicroscopy, Esophagoscopy Flexible Transoral; With Optical Endomicroscopy |
| 43210-CPT | Moderate | Scope Exam Of Stomach, Examination Of The Esophagus Stomach And Small Intestine Using A Scope (Endoscope). The Procedure Includes Tightening The Junction Between The Esophagus And The Stomach. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43210. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43210 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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