CPT 43211 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 • 59 - Distinct Procedural Service • 22 - Increased Procedural Services |
| Complexity Level | Moderate |
| CMS | $224.49 Physician Fee Schedule |
National average reimbursement for CPT 43211 by major payers:
$319.10
$330.75
$328.02
$410.56
| 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 43211 | ||||||
United | 43211 | $2739.00 | 1053770149 - AURORA SURGERY CENTERS, LLC | 811401714 - (WI) AURORA SURGERY CENTERS LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $676.00 | 1376709907 - ARDMORE REGIONAL SURGERY CENTER, LLC | 262814211 - (OK) ARDMORE REGIONAL SURGERY CENTER | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $488.00 | 1386602332 - THREE RIVERS ENDOSCOPY CENTER, INC. | 251788887 - (PA) THREE RIVERS ENDOSCOPY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $970.00 | 1104907328 - ANDREWS INSTITUTE ASC LLC | 352274952 - (FL) ANDREWS INSTITUTE ASC, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $760.00 | 1629094917 - ANNAPOLIS ENT SURGICAL CENTER, LLC | 522337616 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $725.00 | 1952771230 - GEORGIA UROLOGY, PA, GA UROLOGY ASC ROSWELL | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $420.00 | 1790172922 - YUMA VALLEY AMBULATORY PAIN SERVICES INC | 471779727 - (AZ) YUMA VALLEY AMBULATORY PAIN SERVICES INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $735.00 | 1770796757 - LAPEER COUNTY SURGERY CENTER LLC | 202918877 - (MI) LAPEER COUNTY SURGERY CENTER L | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $1258.00 | 1285815522 - TLC ASC, LLC, KZMSS AGAIN, LLLP | 201952603 - (FL) TLC ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $766.00 | 1700263415 - NORTH POINT SURGERY CENTER, LLC | 464488421 - (MO) NORTH POINT SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $1276.00 | 1922611714 - COLORADO UROLOGIC SURGERY CENTER LLC | 851926897 - (CO) COLORADO UROLOGIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $410.00 | 1043284508 - WINTER HAVEN-SEBRING FL OPHTHALMOLOGY ASC LLC, EYE SURGERY & LASER CENTER OF SEBRING | 743072437 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $2000.00 | 1396065082 - PAIN CENTERS OF MINNESOTA-MANKATO, LLC | 272452351 - (MN) PAIN CENTERS OF MINNESOTA-MANKATO, LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $1233.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43211 | $874.00 | 1427094945 - TRI-STATE SURGERY CENTER LLC | 562317091 - TRI STATE SURGERY CENTER, LLC | PA | 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 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 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 |
| 43211-CPT | Moderate | Once Per Dos Esophagoscopy, Flexible, Transoral; W/Endoscopic Mucosal Resection |
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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