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See a sample rate comparisonCPT 43235 Fee Schedule
Last Verified: September 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 Flexible Transoral; Diagnostic Including Collection Of Specimen(S) Bybrushing Or Washing When Performed (Separate Procedure) (Revised 01/01/2014)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 24 - Ambulatory Surgical Center 21 - Inpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43235 |
| Medicaid Fee Schedule | View Medicaid rates for 43235 |
National average reimbursement for CPT 43235 by major payers:
$346.14
$381.06
$430.11
$468.78
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CPT 43235
5 of 25 sample ratesHigher to lower in this preview
Leonardo Holguin
$1,497.06Published rateVivek Ramanathan
$468.67Published rateGhalia Hanif
Geriatric Associates Of Nj LLC
$211.33Published rateGnana Sunderam
Gnana Sunderam Md PC
$185.91Published rateMitchell Brown
$75.33Published rate
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See a sample payer proposalCPT 43235 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43235 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 43235 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 |
|---|---|---|
| 43197-CPT | Moderate | Esophagoscopy Flex Dx Brush, Esophagoscopy Flexible Transnasal Diagnostic Including Collection Of Specimen S By Brushing Or Washing When Performed Separate Procedure |
| 43198-CPT | Moderate | Esophagus Exam With Scope, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy). |
| 43232-CPT | Moderate | Esophagus Exam With Scope, An Exam Of The Esophagus Using A Scope (Endoscope) And Ultrasound (Sound Waves) To Take Pictures. The Procedure Takes A Sample Of Tissue For Testing (Biopsy). |
| 43235-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; Diagnostic Including Collection Of Specimen(S) Bybrushing Or Washing When Performed (Separate Procedure) (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 43235. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43235 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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