CPT 43231 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 • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $149.12 Physician Fee Schedule |
National average reimbursement for CPT 43231 by major payers:
$250.58
$275.83
$284.31
$327.52
| 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 43231 | ||||||
United | 43231 | $775.00 | 1881704237 - WATERFRONT SURGERY CENTER LLC | 251898743 - (PA) WATERFRONT SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $315.00 | 1356646715 - ZACHARY ASC PARTNERS, LLC, ZACHARY ASC PARTNERS, LLC | 273854435 - (LA) ZACHARY ASC PARTNERS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $540.00 | 1457387771 - FOOT & ANKLE SURGERY CENTER | 582658964 - (GA) FOOT ANKLE SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $766.00 | 1851317614 - KENDALL POINTE SURGERY CENTER LLC | 364236445 - (IL) KENDALL POINTE SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $1050.00 | 1649416231 - CLINTON PARTNERS, LLC, SURGERY CENTER OF CLINTON TOWNSHIP | 202236024 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $1266.00 | 1891049441 - ISLAND DIGESTIVE HEALTH CENTER, LLC | 452411095 - (NY) ISLAND DIGESTIVE HEALTH CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $1955.00 | 1982607446 - DENTON SURGICARE PARTNERS, LTD., DENTON SURGICARE | 752708579 - (TX) DENTON SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $931.00 | 1851407373 - RIVERSIDE AMBULATORY SURGERY CENTER, LLC | 320082320 - (IL) RIVERSIDE AMBULATORY SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $588.00 | 1679570774 - NOVAMED SURGERY CENTER OF MADISON, LIMITED PARTNERSHIP | 201915800 - (WI) NOVAMED SURGERY CENTER OF MADISON LIMITED PARTNERSHIP | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $536.00 | 1407004534 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $603.00 | 1649219536 - USC, LLC, UNASOURCE SURGERY CENTER | 352175811 - (MI) USC, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $2709.00 | 1386165504 - THE EMORY CLINIC INC, EMORY AMBULATORY SURGERY CENTER AT SPIVEY STATION | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $924.00 | 1992788772 - EAST JEFFERSON AMBULATORY SURGERY CENTER | 201425074 - (LA) EAST JEFFERSON AMBULATORY | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $1258.00 | 1952814386 - ADVANCED SURGICAL CARE OF BOERNE, LLC | 821680961 - (TX) ADVANCED SURGICAL CARE OF BOERNE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43231 | $1258.00 | 1386277069 - SOUTHWEST ENDOSCOPY LLC | 843623972 | AZ | 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 43231 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43231 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 43231 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 |
|---|---|---|
| 43217-CPT | Moderate | Esophagoscopy Flexible Transoral; With Removal Tumor(S) Polyp(S) Or Other Lesion(S) By Snare Technique (Revised 01/01/2014) |
| 43220-CPT | Moderate | Esophagoscopy Flexible Transoral; With Transendoscopic Balloon Dilation (Less Than 30 Mm Diameter) (Revised 01/01/2014) |
| 43226-CPT | Moderate | Esophagoscopy Flexible Transoral; With Insertionof Guide Wire Followed By Passage Of Dilator(S) Over Guide Wire (Revised 01/01/2014) |
| 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 43231. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43231 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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