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See a sample rate comparisonCPT 43226 Fee Schedule
Medicare rates as of October 2026
CPT 43226 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
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
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $415.17 national non-facility rate (2026) · View Medicare rates for 43226 |
| Medicaid Fee Schedule | $325.495 median of the 8 states in the free preview · View Medicaid rates for 43226 |
National average reimbursement for CPT 43226 by major payers:
$364.08
BCBS / Anthem
$383.79
UnitedHealthcare
$472.01
Aetna
$239.09
Cigna
Compare published rates across providers.
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CPT 43226
5 of 25 sample ratesHigher to lower in this preview
South Bend Specialty Surgery Center, LLC
South Bend Specialty Surgery Center LLC
$2,889.00Published ratePhysician'S Surgery Center Of Knoxville LLC
Physicians Surgery Center Of Knoxville LLC
$1,276.00Published rateAdvanced Surgery Center Of San Antonio, LLC
$1,000.00Published rateMidatlantic Endoscopy LLC, Mid-Atlantic Gastrointestinal Center II
$600.00Published rateAdvanced Eye Surgery Center, LLC
Advanced Eye Surgery Center LLC
$437.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 43226 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43226. 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 |
| 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 |
| 43231-CPT | Moderate | Esophagoscopy Rigid Or Flexib, Esophagoscopy Rigid Or Flexible Diagnostic With Or Without Collection Of Specimens By Brushing Or Washing (Separate Procedure) With Endoscopic Ultrasound Examination. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43226. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43226 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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