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See a sample rate comparisonCPT 43233 Fee Schedule
Last Verified: October 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.
Esophagogastroduodenoscopy Fl, Esophagogastroduodenoscopy Flexible Transoral With Dilation Of Esophagus With Balloon (30 Mm Diameter Or Larger) (Includes Fluoroscopic Guidance When Performed)
| 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 | 59 - Distinct Procedural Service SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $204.08 national non-facility rate (2026) · View Medicare rates for 43233 |
| Medicaid Fee Schedule | $161.785 median of the 8 states in the free preview · View Medicaid rates for 43233 |
National average reimbursement for CPT 43233 by major payers:
$302.15
$320.13
$328.42
$389.36
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CPT 43233
5 of 25 sample ratesHigher to lower in this preview
Penn Presbyterian Medical Center Spu
Presbyterian Medical Center Of The University Of Pennsylvania Health
$2,709.00Published rateBecker Plastic Surgery Center
Becker Plastic Surgery Center, LLC
$1,028.00Published ratePacific Northwest Surgery Center LLC
$734.00Published rateWarm Springs Surgical Center, LLC, Warm Springs Surgical Center
Warm Springs Surgical Center LLC
$560.00Published rateClarksville Eye Surgery Center
$422.00Published rate
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See a sample payer proposalCPT 43233 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43233 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 43233 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. |
| 43233-CPT | Moderate | Esophagogastroduodenoscopy Fl, Esophagogastroduodenoscopy Flexible Transoral With Dilation Of Esophagus With Balloon (30 Mm Diameter Or Larger) (Includes Fluoroscopic Guidance 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 43233. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43233 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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