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 |
| CMS | $413.07 Physician Fee Schedule |
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 | $2500.00 | 1245529189 - CAPITOL SURGICAL CENTER LLC | 275067646 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $900.00 | 1992777643 - CAPE CORAL FT MYERS ENDOSCOPY ASC LLC, GULF COAST ENDOSCOPY CENTER SOUTH | 621767599 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1265.00 | 1083670939 - CARBON SCHUYLKILL ENDOSCOPY CENTER,INC | 731662391 - (PA) CARBON SCHUYLKILL ENDOSCOPY CENTERINC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1033.00 | 1578986550 - SUMMERVILLE ENDOSCOPY CENTER, LLC | 455241903 - (SC) SUMMERVILLE ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1947.00 | 1104880723 - WNC EYE SURGERY CENTERS INC | 200067898 - (NC) WNC EYE SURGERY CENTERS INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1737.00 | 1467637116 - INLAND NORTHWEST SURGERY CENTER PLLC | 911719918 - (WA) INLAND NORTHWEST SURGERY CENTER PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1869.00 | 1801952783 - AMBULATORY SURGICENTER OF DOWNERS GROVE | 364106726 - (IL) AMBULATORY SURGICENTER OF DOWNERS GROVE | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $1150.00 | 1336100189 - ST MICHAELS SURGERY CENTER INC. | 593748609 - (FL) ST MICHAELS SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $11819.00 | 1881678662 - SURGERY AFFILIATE OF EL PASO, LLC, FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC | 742797719 - (TX) SURGERY AFFILIATE OF EL PASO LLC | TX | 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 | $1679.00 | 1619487782 - UCH VASCULAR ACCESS ASC LLC | 820975009 - (TN) UCH VASCULAR ACCESS ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $2204.00 | 1265679674 - GEORGIA UROLOGY FAYETTE ASC | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $2010.00 | 1285171538 - EYE 35 ASC. LLC | 814995275 - (TX) EYE 35 ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43210 | $4302.00 | 1851407399 - SOUTHERN NEW MEXICO SURGERY CENTER, LLC | 201826172 - (NM) SOUTHERN NEW MEXICO SURGERY CENTER | NM | 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 | 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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