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See a sample rate comparisonCPT 43220 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.
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 | None GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43220 |
| Medicaid Fee Schedule | View Medicaid rates for 43220 |
National average reimbursement for CPT 43220 by major payers:
$792.95
$970.17
$1,111.10
$272.50
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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 CPT 43220 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 43220 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 |
|---|---|---|
| 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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