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See a sample rate comparisonCPT 43236 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.
Digestive Tract Scope Exam, Exam Of The Esophagus Stomach And Intestines Using A Scope (Endoscope). The Procedure May Remove A Tissue Sample For Testing (Biopsy) Or Treat Bleeding.
| 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 | 59 - Distinct Procedural Service XS - Separate Structure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $446.24 national non-facility rate (2026) · View Medicare rates for 43236 |
| Medicaid Fee Schedule | $349.45 median of the 8 states in the free preview · View Medicaid rates for 43236 |
National average reimbursement for CPT 43236 by major payers:
$468.63
$491.58
$558.90
$257.81
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CPT 43236
5 of 25 sample ratesHigher to lower in this preview
Summit Orthopedics Ltd, Eagan Surgery Center
Summit Orthopedics, Ltd.
$2,701.00Published rateLindenhurst Surgery Center LLC, Red Oaks Surgical Suites
Lindenhurst Surgery Center LLC
$1,300.00Published rateWestern PA Surgery Center, Wexford Branch, LLC, Western PA Surgery Center
Western PA Surgery Center
$893.00Published rateEagle Eye Surgery And Laser Center LLC, Eagle Eye Surgery & Laser Center
Eagle Eye Surgery And Laser Center LLC
$544.00Published rateLakeforest Ambulatory Surgery Center, District Heights Ambulatory Surgery Center
Lakeforest Ambulatory Surgery Center
$323.00Published rate
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See a sample payer proposalCPT 43236 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43236 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 43236 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 |
|---|---|---|
| 43235-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; Diagnostic Including Collection Of Specimen(S) Bybrushing Or Washing When Performed (Separate Procedure) (Revised 01/01/2014) |
| 43236-CPT | Moderate | Digestive Tract Scope Exam, Exam Of The Esophagus Stomach And Intestines Using A Scope (Endoscope). The Procedure May Remove A Tissue Sample For Testing (Biopsy) Or Treat Bleeding. |
| 43237-CPT | Moderate | Ultrasound Of Esophagus, Ultrasound (Sound Waves) Taken Of The Esophagus During A Scope Exam (Endoscopy) Of The Digestive Tract. The Procedure May Remove A Sample Of Tissue From The Esophagus For Testing (Biopsy). |
| 43238-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Transendoscopic Ultrasound-Guided Intramural Or Transmural Fine Needle Aspiration/Biopsy(S) Esophagus (Includes Endoscopic Ultrasound Examination Limited To The Esophagus Stomach Or Duodenum And Adjacent Structures) (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 43236. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43236 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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