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 | Esophagoscopy Procedures Endoscopy Procedures on the Esophagus |
| 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
$331.81
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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 |
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CPT 43214 vs. Other Endoscopy Procedures on the Esophagus Codes
The CPT 43214 code is part of the Esophagoscopy Procedures services used for Endoscopy Procedures on the Esophagus. 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 | 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 |
| 43215-CPT | Moderate | Esophagoscopy Rigid Or Flexib, Esophagoscopy Rigid Or Flexible With Removal Of Foreignbody Esophagoscopy Rigid Or Flexible With Removal Of Foreign |
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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