CPT 43210 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 | • None • 62 - Co-Surgeons • UB |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43210 |
National average reimbursement for CPT 43210 by major payers:
$575.35
$597.74
$601.96
$726.72
| 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 43210 | ||||||
United | 43210 | $1630.00 | 1417958729 - MENTOR SURGERY CENTER LTD | 341863257 - (OH) MENTOR SURGERY CENTER,LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $4339.00 | 1902302961 - HILL COUNTRY SURGERY CENTER, LLC, SURGERY CENTER OF BOERNE | 352599588 - (TX) HILL COUNTRY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $3623.00 | 1730318353 - GARDENDALE SURGICAL ASSOCIATES, LLC | 205936644 - (AL) GARDENDALE SURGICAL ASSOCIATES | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $3203.00 | 1881238632 - UNITED MEDICAL PARK ASC LLC | 831720113 - (IA) UNITED MEDICAL PARK ASC LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $2122.00 | 1457957391 - MIDDLEBROOK ASC, LLC | 843656261 - (TN) MIDDLEBROOK ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $5859.00 | 1629738471 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS, PREVEA SURGERY CENTER | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $2277.00 | 1326469172 - EHI SURGERY CENTER AUSTIN, LLC | 464266877 - (TX) EHI SURGERY CENTER AUSTIN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1609.00 | 1366635609 - APPLE SURGERY CENTER, INC | 260423287 - (CA) APPLE SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $4140.00 | 1093383655 - SHERMAN ENDOSCOPY CENTER, LLC | 861402910 - (TX) SHERMAN ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $3350.00 | 1912909433 - CENTENNIAL SURGUNIT, LLC, CENTENNIAL SURGERY CENTER | 223580847 - (NJ) CENTENNIAL SURGUNIT LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $2591.00 | 1184106049 - SURGCENTER OF NORTHERN BALTIMORE, LLC | 823078615 - (MD) SURGCENTER OF NORTHERN BALTIMORE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $3124.00 | 1770513855 - CAPITAL ENDOSCOPY LLC | 134244093 - (MD) CAPITAL ENDOSCOPY & SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1679.00 | 1619487782 - UCH VASCULAR ACCESS ASC LLC | 820975009 - (TN) UCH VASCULAR ACCESS ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1522.00 | 1093779951 - EYE SURGERY AND LASER CLINIC, INC. | 562172461 - (NC) EYE SURGERY AND LASER CLINIC INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1984.00 | 1538167978 - VALLEY SURGICAL CENTER LTD, VALLEY SURGERY CENTER | 300035229 - (OH) VALLEY SURGICAL CENTER LTD | OH | 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 43210 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43210 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 43210 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 |
|---|---|---|
| 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) |
| 43206-CPT | Moderate | Esophagoscopy Flexible Transoral; With Optical Endomicroscopy (Revised 01/01/2014) |
| 43210-CPT | Moderate | Once Per Dos Esophagogastroduodenoscopy, Flexible, Transoral; W Esophagogastric Fundoplasty, Partial Or Complete, Includes Duodenoscopy When Performed- Deny Inv/N10>=1/1/16 |
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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