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 |
| CMS | $188.26 Physician Fee Schedule |
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 | $605.00 | 1760445928 - ARIZONA ENDOSCOPY CENTER, LLC | 860908400 - (AZ) ARIZONA ENDOSCOPY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $997.00 | 1619013455 - RUSH SURGICENTER AT THE PROFESSIONAL BUILDING LTD. PARTNERSHIP, RUSH SURGICENTER LTD. PARTNERSHIP | 363853026 - (IL) RUSH SURGICENTER, LTD. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $433.00 | 1679521389 - WESLEY & KLIPPENSTEIN, PC, WESLEY OPHTHALMIC PLASTIC SURGERY CENTER | 621799761 - (TN) WESLEY & KLIPPENSTEIN, P.C. | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $478.00 | 1780661967 - CJ ELMWOOD PARTNERS L P | 911793912 - CJ ELMWOOD PARTNERS L P | IA | 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 | $750.00 | 1457670648 - THE RETINA SURGERY CENTER LLC, THE RETINA SURGERY CENTER | 853784941 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $846.00 | 1376885400 - MD ANAHEIM SURGERY CENTER INC | 462311690 - (CA) MD ANAHEIM SURGERY CENTER INC | CA | 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 | $1664.00 | 1255346045 - OMEGA SURGERY CENTER LLC | 470821405 - (NE) OMEGA SURGERY CENTER LLC | NE | 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 | $3024.00 | 1053770149 - AURORA SURGERY CENTERS, LLC | 811401714 - (WI) AURORA SURGERY CENTERS LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $1229.00 | 1265486849 - FEATHERSTONE PARTNERSHIP LP, ROCKFORD AMBULATORY SURGERY CENTER | 363861021 - (IL) THE FEATHERSTONE PARTNERSHIP L. P. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $960.00 | 1184680407 - OAK BROOK SURGICAL CENTRE INC. | 363317971 - (IL) OAKBROOK SURGICAL CENTRE, INC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $622.00 | 1477542520 - THE EYE SURGERY CENTER, LTD. | 263915695 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43214 | $840.00 | 1629075106 - MICHIGAN ENDOSCOPY CENTER LLC | 364469630 - (MI) MICHIGAN ENDOSCOPY CENTER LLC | MI | 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 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.
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