CPT 43214 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • GC - Service performed by resident under supervision • XS - Separate Structure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43214 |
National average reimbursement for CPT 43214 by major payers:
$265.41
$269.52
$271.99
$337.70
| 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 43214 | ||||||
United | 43214 | $800.00 | 1427545540 - ORBIS SURGERY CENTER LLC | 825184428 - (TX) ORBIS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $773.00 | 1285213009 - UM SHORE REGIONAL HEALTH SURGERY CENTER AT CAMBRIDGE, LLC, UM SHORE REGIONAL HEALTH SURGERY CENTER AT CAMBRIDGE | 372002744 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $884.00 | 1598390015 - CHRISTUS SURGERY CENTER VILLAGES LLC, CHRISTUS SURGERY CENTER - SHREVEPORT | 844975265 - (LA) CHRISTUS SURGERY CENTER VILLAGES LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $495.00 | 1598068306 - EXECUTIVE PARK SURGERY CENTER OF FORT SMITH, INC | 273053996 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $2782.00 | 1689639262 - OAKWOOD SURGERY CENTER, LTD., LLP | 621641024 - (TX) OAKWOOD SURGERY CENTER LTD LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $433.00 | 1265442537 - BRIGHTON SURGERY CENTER, LLC | 743060570 - (NY) BRIGHTON SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $699.00 | 1225377278 - CENTER FOR MINIMALLY INVASIVE SURGERY PLLC, SOUNDVIEW AMBULATORY SURGERY CENTER | 911661866 - (WA) CENTER FOR MINIMALLY INVASIVE SURGERY, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $1500.00 | 1518057546 - LONG ISLAND AMBULATORY SURGERY CENTER, LLC | 200369668 - (NY) LONG ISLAND AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $734.00 | 1366868572 - PREMIER SURGERY CENTER, LLC | 463321793 - (NC) PREMIER SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $1258.00 | 1144287665 - CHANNEL ISLANDS SURGICENTER LP | 770418197 - (CA) CHANNEL ISLANDS SURGICENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $845.00 | 1114291440 - PREMIER ASC LLC, PREMIER ORTHOPAEDIC SURGERY CENTER | 352433859 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $950.00 | 1881687614 - TURKS HEAD SURGERY CENTER LLC | 200184603 - (PA) TURK'S HEAD SURGERY CENTER, L.L.C. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $1044.00 | 1033220751 - ENDOSCOPY CENTER AT ST MARY | 205253494 - (PA) ENDOSCOPY CENTER AT ST MARY | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $433.00 | 1275501512 - NORTHWEST KANSAS SURGERY CENTER, LLC | 481209668 - (KS) NORTHWEST KANSAS SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $952.00 | 1063733095 - WOLFE SURGERY CENTER, LLC | 272625124 - (IA) WOLFE SURGERY CENTER LLC | IA | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 43214 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43214 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 43214 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 |
|---|---|---|
| 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) |
| 43215-CPT | Moderate | Esophagoscopy Flexible Transoral; With Removal Of Foreign Body(S) (Revised 01/01/2015) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43214. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43214 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43214) and we'll show you how you compare in 15 minutes or less.