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See a sample rate comparisonCPT 43210 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.
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 | None 62 - Co-Surgeons UB |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43210 |
| Medicaid Fee Schedule | View Medicaid rates for 43210 |
National average reimbursement for CPT 43210 by major payers:
$575.35
$597.74
$601.96
$704.32
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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 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 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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