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See a sample rate comparisonCPT 43220 Fee Schedule
Medicare rates as of October 2026
CPT 43220 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Esophagus Enlargement, Exam Of The Esophagus Aided By A Scope (Endoscope). The Procedure Inserts A Balloon That Is Inflated In Order To Enlarge Or Open Up The Esophagus.
| 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 | GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $957.94 national non-facility rate (2026) · View Medicare rates for 43220 |
| Medicaid Fee Schedule | $757.725 median of the 8 states in the free preview · View Medicaid rates for 43220 |
National average reimbursement for CPT 43220 by major payers:
$792.95
BCBS / Anthem
$970.17
UnitedHealthcare
$1,111.10
Aetna
$272.50
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43220.
CPT 43220
5 of 25 sample ratesHigher to lower in this preview
Saint Lukes-Gi Diagnostics LLC
Saint Lukesgi Diagnostics LLC
$3,105.00Published rateMedical City Surgery Center Of Frisco, LLC
Medical City Surgery Center Of Frisco LLC
$1,809.00Published rateAllina Health Surgery Center- Vadnais Heights LLC
Allina Health Surgery Center Vadnais Heights LLC
$1,143.00Published rateSutter Bay Medical Foundation
$753.50Published rateWest Florida Surgery Center Inc
$412.00Published rate
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See a sample payer proposalCPT 43220 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43220. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 43220-CPT | Moderate | Esophagus Enlargement, Exam Of The Esophagus Aided By A Scope (Endoscope). The Procedure Inserts A Balloon That Is Inflated In Order To Enlarge Or Open Up The Esophagus. |
| 43226-CPT | Moderate | Esophagoscopy Rigid Or Flexib, Esophagoscopy Rigid Or Flexible With Insertion Of Guidewire Followed By Dilation Over Guide Wire Esophagoscopy Rigid Or Flexible With Insertion Of Guide |
| 43227-CPT | Moderate | Control Bleeding In Esophagus, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure Includes Control Of Bleeding In The Esophagus. |
| 43229-CPT | Moderate | Esophagoscopy Lesion Ablate, Esophagoscopy Flexible Transoral With Ablation Of Tumor S Polyp S Or Other Lesion S Includes Pre And Post Dilation And Guide Wire Passage When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43220. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43220 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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