CPT 43213 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 52 - Reduced Services • GC - Service performed by resident under supervision |
| Complexity Level | High |
| CMS | $1,131.16 Physician Fee Schedule |
National average reimbursement for CPT 43213 by major payers:
$1,389.93
$1,646.15
$1,676.78
$1,975.72
| 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 43213 | ||||||
United | 43213 | $611.00 | 1750612446 - BAY SURGERY CENTERS, CLEARWAY SURGERY CENTER OF GLEN BURNIE | 271271303 - (MD) BAY SURGERY CENTERS | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $1440.00 | 1063750867 - MENLO PARK SURGERY CENTER, LLC. | 263669436 - (NJ) MENLO PARK SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $650.00 | 1326388000 - SOUTHEASTERN ORTHOPAEDICS SURGERY CENTER | 352467951 - (GA) SOUTHEASTERN ORTHOPAEDICS SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $1258.00 | 1104181247 - ADVANCED SURGERY CENTER OF NORTHERN LOUISIANA LLC | 455502071 - (LA) ADVANCED SURGERY CENTER OF NORTHERN LOUISIANA, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $363.00 | 1235105248 - GURLEY SURGERY CENTER, THE GYN CENTER | 621159796 - (TN) GURLEY SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $530.00 | 1992785232 - NORTHWEST FLORIDA A S C LP, NORTHWEST FLORIDA GASTROENTEROLOGY CENTER | 621647401 - (FL) NORTHWEST FLORIDA A S C LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $1375.00 | 1073578019 - BLUE RIDGE DAY SURGERY CENTER, LP, BLUE RIDGE DAY SURGERY CENTER | 621530122 - (NC) BLUE RIDGE DAY SURGERY CENTER LP | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $825.00 | 1376607309 - EMERALD SURGICAL CENTER LLC | 820485376 - (ID) EMERALD SURGICAL CENTER, L.L.C. | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $3494.00 | 1114168309 - MEMORIAL CARE SURGICAL CENTER AT ORANGE COAST, LLC | 261394069 - (CA) MEMORIAL CARE SURGICAL CENTER AT ORANGE COAST LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $2817.00 | 1427491547 - MEMORIAL HERMANN TEXAS INTERNATIONAL ENDOSCOPY CENTER, LLC, TEXAS INTERNATIONAL ENDOSCOPY CENTER | 462464605 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $656.00 | 1144845116 - LEGACY CENTER FOR SPINAL SURGERY, LLC | 843166515 - (GA) LEGACY CENTER FOR SPINAL SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $734.00 | 1982853271 - WESTERN WASHINGTON ENDOSCOPY CENTERS LLC, SUNRISE ENDOSCOPY CENTER | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $1035.00 | 1053381236 - METHODIST SURGERY CENTER GERMANTOWN LP | 621659904 - (TN) METHODIST SURGERY CENTER GERMANTOWN LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $474.00 | 1427787142 - CAPITAL SURGERY CENTER LLC | 861660213 - (LA) CAPITAL SURGERY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43213 | $719.00 | 1366117988 - KANSAS SURGERY CENTER, LLC | 853914447 - (KS) KANSAS SURGERY CENTER LLC | KS | 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 43213 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43213 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 43213 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 |
|---|---|---|
| 43211-CPT | Moderate | Once Per Dos Esophagoscopy, Flexible, Transoral; W/Endoscopic Mucosal Resection |
| 43212-CPT | Moderate | Esophagoscopy, Flexible, Transoral; With Placement Of Endoscopic Stent (Includes Pre- And Post-Dilation And Guide Wire Passage, When Performed) |
| 43213-CPT | High | Esophagoscopy, Flexible, Transoral; With Dilation Of Esophagus, By Balloon Or Dilator, Retrograde (Includes Fluoroscopic Guidance, When Performed) |
| 43214-CPT | Moderate | 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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