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See a sample rate comparisonCPT 43211 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.
Esophagus Exam With Scope, An Exam Of The Esophagus Using A Scope (Endoscope). The Procedure Includes Removing Tissue From The Digestive Tract.
| 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 59 - Distinct Procedural Service 22 - Increased Procedural Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43211 |
| Medicaid Fee Schedule | View Medicaid rates for 43211 |
National average reimbursement for CPT 43211 by major payers:
$319.10
$330.75
$328.02
$402.81
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CPT 43211
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Sugar Land LLP
$2,480.00Published rateMaine Eye Care Associates, Maine Eye Care Surgery Center
Eye Care Of Maine, P.A. F/K/A Maine Eye Care, P.A.
$1,245.00Published rateNorth Point Surgery Center, LLC
North Point Surgery Center LLC
$766.00Published rateNewbridge Surgery Center At Prince Frederick, LLC
Newbridge Surgery Center At Prince Frederick LLC
$522.00Published rateGurley Surgery Center, The Gyn Center
Gurley Surgery Center
$363.00Published rate
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See a sample payer proposalCPT 43211 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43211 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 43211 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 |
|---|---|---|
| 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. |
| 43211-CPT | Moderate | Esophagus Exam With Scope, An Exam Of The Esophagus Using A Scope (Endoscope). The Procedure Includes Removing Tissue From The Digestive Tract. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43211. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43211 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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