CPT 43215 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| CMS | $373.28 Physician Fee Schedule |
National average reimbursement for CPT 43215 by major payers:
$365.82
$414.97
$504.76
$584.33
| 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 43215 | ||||||
United | 43215 | $1528.00 | 1891450805 - NORTH DENVER MUSCULOSKELETAL SURGICAL PARTNERS LLC | 364920288 - (CO) NORTH DENVER MUSCULOSKELETAL SURGICAL PARTNERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $1258.00 | 1053764779 - SURGCENTER OF ST. LUCIE, LLC | 475425011 - (FL) SURGCENTER OF ST. LUCIE, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $1200.00 | 1649350844 - NORTHERN PLAINS SURGERY CENTER LLC | 450447247 - (ND) NORTHERN PLAINS SURGERY CENTER, LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $820.00 | 1306375837 - CENTRAL COAST CARDIOVASCULAR ASC LLC | 821736669 - (CA) CENTRAL COAST CARDIOVASCULAR ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $753.50 | 1447788120 - NORCAL ORTHOPEDIC SURGERY CENTER, LLC | 821046949 - (CA) NORCAL ORTHOPEDIC SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $334.00 | 1063415891 - HARRISON SURGERY CENTER, LLC | 201117764 - (AR) HARRISON SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $1233.00 | 1316508252 - MINIMALLY INVASIVE SURGICENTER LLC | 842130499 - (FL) MINIMALLY INVASIVE SURGICENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $461.00 | 1205439650 - TRIAD SURGERY CENTER LLC | 473510624 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $781.00 | 1043612534 - HHC ASC, LLC | 824195385 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $1955.00 | 1073694550 - ROCKWALL AMBULATORY SURGERY CENTER LLP, BAYLOR SCOTT & WHITE SURGICARE - ROCKWALL | 205506447 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $3066.00 | 1457960536 - LAKE GEORGE SURGERY CENTER, LLC | 844411548 - (IN) LAKE GEORGE SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $2089.00 | 1154369114 - CHRISTUS SANTA ROSA PASC-SAN ANTONIO LLC, CHRISTUS SURGERY CENTER - ALAMO HEIGHTS | 412092141 - (TX) CHRISTUS SRPASC - SAN ANTONIO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $536.00 | 1528039567 - PREMIER PROFESSIONAL SURGERY CENTER PC, PARKEYE SURGI CENTER | 381894684 - (MI) PARK EYE & SURGI CENTER | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $1250.00 | 1528553559 - SURGICAL PAIN CENTER OF THE ADIRONDACKS, LLC | 821943675 - (NY) SURGICAL PAIN CENTER OF THE ADIRONDACKS LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43215 | $544.00 | 1730252487 - J C PITTS ENTERPRISES INC, ONTARIO SURGERY CENTER | 930983555 - (OR) J C PITTS ENTERPRISES INC | OR | 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 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 | 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 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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