CPT 43227 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 | • 21 - Inpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • XS - Separate Structure • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $557.33 Physician Fee Schedule |
National average reimbursement for CPT 43227 by major payers:
$558.09
$638.86
$741.89
$884.80
| 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 43227 | ||||||
United | 43227 | $3843.00 | 1437746674 - SUMMIT ORTHOPEDIC SURGERY CENTER, LLC, SOSC | 844141051 - (CO) SUMMIT ORTHOPEDIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $830.00 | 1538316278 - PHYSICIANS' SURGERY CENTER OF DOWNEY, LLC | 205170962 - (CA) PHYSICIANS SURGERY CENTER OF | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $2036.00 | 1073113841 - SPINE SOLUTIONS OF WEST BEND LLC | 853661644 - (WI) SPINE SOLUTIONS OF WEST BEND LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $753.50 | 1801822739 - SYLVAN SURGERY CENTER, INC. | 200500901 - (CA) SYLVAN SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $645.00 | 1124587548 - GATEWAY SURGICAL CENTER, LLC | 830521568 - (TX) GATEWAY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $1179.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $614.00 | 1295385482 - JOHNS HOPKINS SURGERY CENTERS SERIES | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $1299.00 | 1083785398 - OLYMPIA ORTHOPAEDIC ASSOCIATES PLLC, OLYMPIA SURGERY CENTER LLC | 911674528 - OLYMPIA ORTHOPAEDIC ASSOCIATES, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $1258.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $875.00 | 1912547746 - PORT ARTHUR SURGICAL CENTER, LLC, GULF COAST SURGERY CENTER | 843158723 - (TX) PORT ARTHUR SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $1258.00 | 1215492061 - ADVANCED SPINE CENTER OF WISCONSIN, LLC | 832438541 - (WI) ADVANCED SPINE CENTER OF WISCONSIN | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $1233.00 | 1871594275 - DESTIN SURGERY CENTER LLC | 593723179 - (FL) DESTIN SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $1258.00 | 1649515354 - SURGCENTER NORTHEAST LLC | 455554995 - (FL) SURGCENTER NORTHEAST, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $600.00 | 1396123865 - SOUND SURGEONS PLLC, NORTHWEST WEIGHT LOSS SURGERY | 461190829 - (WA) SOUND SURGEONS, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43227 | $1200.00 | 1609977610 - UOC SURGICAL SERVICES, LTD. | 251890694 - (PA) UOC SURGICAL SERVICES LTD | PA | 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 43227 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43227 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 43227 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 | Esophagoscopy Flexible Transoral; With Transendoscopic Balloon Dilation (Less Than 30 Mm Diameter) (Revised 01/01/2014) |
| 43227-CPT | Moderate | Esophagoscopy Flexible Transoral; With Control Of Bleeding Any Method (Revised 01/01/2014) |
| 43229-CPT | Moderate | 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 Flexible Transoral; With Endoscopic Ultrasound Examination (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43227. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43227 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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