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See a sample rate comparisonCPT 43211 Fee Schedule
Medicare rates as of October 2026
CPT 43211 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
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 | 59 - Distinct Procedural Service 22 - Increased Procedural Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $206.75 national non-facility rate (2026) · View Medicare rates for 43211 |
| Medicaid Fee Schedule | $167.555 median of the 8 states in the free preview · View Medicaid rates for 43211 |
National average reimbursement for CPT 43211 by major payers:
$319.10
BCBS / Anthem
$330.75
UnitedHealthcare
$328.02
Aetna
$402.81
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43211.
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 table lists codes related to 43211. Select one to see its fee schedule.
| 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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