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See a sample rate comparisonCPT 43213 Fee Schedule
Medicare rates as of October 2026
CPT 43213 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Esophagoscopy Retro Balloon, Esophagoscopy Flexible Transoral With Dilation Of Esophagus By Balloon Or Dilator Retrograde Includes Fluoroscopic Guidance When Performed
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | 52 - Reduced Services GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | $1,254.20 national non-facility rate (2026) · View Medicare rates for 43213 |
| Medicaid Fee Schedule | $988.355 median of the 8 states in the free preview · View Medicaid rates for 43213 |
National average reimbursement for CPT 43213 by major payers:
$1,389.93
BCBS / Anthem
$1,646.15
UnitedHealthcare
$1,676.78
Aetna
$510.44
Cigna
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CPT 43213
5 of 25 sample ratesHigher to lower in this preview
West Penn Allegheny Health System Inc., Allegheny General Hospital
Highmark Health
$5,747.16Published rateOrange Park Endoscopy Center LLC
Surgcenter Of Orange Park LLC
$1,528.00Published rateAlexandria Carie-Kroeger
Deaconess Hospital Inc
$953.34Published rateHigh Resort Eye Surgery Center LLC
$582.00Published rateLisa Renfro Surgery Center LLC
$420.00Published rate
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See a sample payer proposalCPT 43213 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43213. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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 |
| 43214-CPT | Moderate | Esophagosc Dilate Balloon 30, Esophagoscopy Flexible Transoral With Dilation Of Esophagus With Balloon 30 Mm Diameter Or Larger 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 43213. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43213 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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