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See a sample rate comparisonCPT 43212 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.
Esophagoscop Stent Placement, Esophagoscopy Flexible Transoral With Placement Of Endoscopic Stent Includes Pre And Post Dilation And Guide Wire Passage When Performed
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None GC - Service performed by resident under supervision 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43212 |
| Medicaid Fee Schedule | View Medicaid rates for 43212 |
National average reimbursement for CPT 43212 by major payers:
$259.50
$265.08
$277.41
$323.55
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CPT 43212
5 of 25 sample ratesHigher to lower in this preview
Prime Healthcare Services-Suburban Hospital LLC
$8,886.45Published ratePankratz Eye Institute, LLC, Columbus Eye Sugery Center, LLC, Dba Pankratz Eye Institute
Pankratz Eye Institute LLC
$3,623.00Published rateNorthern California Advanced Surgery Center Lp
Northern California Advanced Surgery Center, Lp
$2,325.00Published rateQuality Care Surgery Center, LLC
Quality Care Surgery Center LLC
$1,880.00Published rateGastro Care, LLC
Gastro Care LLC
$713.00Published rate
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See a sample payer proposalCPT 43212 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43212 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 43212 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 |
|---|---|---|
| 43206-CPT | Moderate | Esophagoscopy Flex Transoral; W/ Optical Endomicroscopy, Esophagoscopy Flexible Transoral; With Optical Endomicroscopy |
| 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. |
| 43212-CPT | Moderate | Esophagoscop Stent Placement, Esophagoscopy Flexible Transoral With Placement Of Endoscopic Stent Includes Pre And Post Dilation And Guide Wire Passage When Performed |
| 43213-CPT | High | Esophagoscopy Retro Balloon, Esophagoscopy Flexible Transoral With Dilation Of Esophagus By Balloon Or Dilator Retrograde Includes Fluoroscopic Guidance When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43212. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43212 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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