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See a sample rate comparisonCPT 43231 Fee Schedule
Medicare rates as of October 2026
CPT 43231 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
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.
| 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 | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $137.95 national non-facility rate (2026) · View Medicare rates for 43231 |
| Medicaid Fee Schedule | $126.745 median of the 8 states in the free preview · View Medicaid rates for 43231 |
National average reimbursement for CPT 43231 by major payers:
$250.58
BCBS / Anthem
$275.83
UnitedHealthcare
$284.31
Aetna
$280.03
Cigna
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CPT 43231
5 of 25 sample ratesHigher to lower in this preview
Northwest Surgery Center LLC, Foot & Ankle Surgery Center
$3,994.00Published rateShriners Hospitals For Children, Shriners Hospitals For Children Ambulatory Surgery Center-Lexington
Shriners Hospitals For Children
$1,450.00Published rateVoorhees Surgery Center, LLC
Voorhees Surgery Center LLC
$1,104.00Published rateWestern Washington Endoscopy Centers LLC, Peninsula Endoscopy Center
Western Washington Endoscopy Centers LLC
$734.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$536.00Published rate
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See a sample payer proposalCPT 43231 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43231. Select one to see its fee schedule.
| 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 | 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 |
| 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 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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