CPT 43233 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 24 - Ambulatory Surgical Center |
| Common Modifiers | None 59 - Distinct Procedural Service SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43233 |
National average reimbursement for CPT 43233 by major payers:
$302.15
$320.13
$328.42
$389.36
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 43233 | $525.00 | 1417295528 - ATLANTA GENERAL AND BARIATRIC SURGERY CENTER, LLC | 460797514 - (GA) ATLANTA GENERAL AND BARIATRIC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $1183.00 | 1831109560 - NEW MEXICO ORTHOPAEDIC SURGERY CENTER, LLC, NEW MEXICO SURGERY CENTER ORTHOPAEDICS | 621797896 | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $560.00 | 1114361185 - WARM SPRINGS SURGICAL CENTER, LLC, WARM SPRINGS SURGICAL CENTER | 461892306 - (NV) WARM SPRINGS SURGICAL CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $475.00 | 1467032862 - MIDWEST EYE CONSULTANTS, P.C. | 351845786 - (IN) MIDWEST EYE CONSULTANTS, P.C. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $1258.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $468.00 | 1942485305 - 9106 PHILADELPHIA ROAD AMBULATORY SURGERY CENTER LLC | 261539834 - (MD) 9106 PHILADELPHIA ROAD AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $734.00 | 1912641788 - PACIFIC NORTHWEST SURGERY CENTER LLC | 842331435 - (OR) PACIFIC NORTHWEST SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $507.00 | 1053058255 - INDIANA VASCULAR SURGERY CENTER LLC | 871608290 - (IN) INDIANA VASCULAR SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $513.00 | 1518998764 - TENNESSEE PAIN SURGERY CENTER, LLC | 621790133 - (TN) TENNESSEE PAIN SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $565.00 | 1225199482 - ST MARKS SURGICAL CENTER LLC | 364577700 - (FL) ST MARKS SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $670.00 | 1396142733 - DIALYSIS ACCESS SERVICES, LLC | 472322456 - (MD) DIALYSIS ACCESS SERVICES LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $947.00 | 1780109934 - BANNER MESA SURGERY CENTER LLC | 901182682 - (AZ) BANNER MESA SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $840.00 | 1891312815 - SACRED HEART ASC, LLC | 830521940 - (FL) SACRED HEART ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $1233.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43233 | $725.00 | 1043660442 - GEORGIA INTERVENTIONAL PAIN | 812790376 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | 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 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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