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See a sample rate comparisonCPT 43215 Fee Schedule
Last Verified: September 2026
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.
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 | None 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43215 |
| Medicaid Fee Schedule | View Medicaid rates for 43215 |
National average reimbursement for CPT 43215 by major payers:
$365.82
$414.97
$504.76
$258.58
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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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See a sample payer proposalCPT 43215 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43215 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 43215 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 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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