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See a sample rate comparisonCPT 43215 Fee Schedule
Medicare rates as of October 2026
CPT 43215 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Esophagoscopy Rigid Or Flexib, Esophagoscopy Rigid Or Flexible With Removal Of Foreignbody Esophagoscopy Rigid Or Flexible With Removal Of Foreign
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $436.55 national non-facility rate (2026) · View Medicare rates for 43215 |
| Medicaid Fee Schedule | $341.065 median of the 8 states in the free preview · View Medicaid rates for 43215 |
National average reimbursement for CPT 43215 by major payers:
$365.82
BCBS / Anthem
$414.97
UnitedHealthcare
$504.76
Aetna
$258.58
Cigna
Compare published rates across providers.
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CPT 43215
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Preston Road, Ltd., Doctors United Surgery Center
Memorial Hermann Surgery Center Preston Road Ltd
$2,817.00Published rateSummit Ambulatory Surgical Center, LLC
$1,233.00Published rateNorthwest Endo Center LLC
$819.00Published rateEscnc LLC, Eye Surgery Center Of Northern California
Escnc LLC
$596.00Published rateHarrison Surgery Center, LLC
Harrison Surgery Center LLC
$334.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 43215 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43215. Select one to see its fee schedule.
| 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 43215. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43215 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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