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See a sample rate comparisonCPT 43240 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 Flexible Transoral; With Transmural Drainage Of Pseudocyst (Includes Placement Of Transmural Drainage Catheter[S]/ Stent[S] When Performed And Endoscopic Ultrasound When Performed) (Revised 01/01/2014)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | AG - Primary physician 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $342.03 national non-facility rate (2026) · View Medicare rates for 43240 |
| Medicaid Fee Schedule | $275.285 median of the 8 states in the free preview · View Medicaid rates for 43240 |
National average reimbursement for CPT 43240 by major payers:
$506.35
$532.90
$574.07
$639.83
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CPT 43240
5 of 25 sample ratesHigher to lower in this preview
Baylor Surgicare At Granbury LLC, Baylor Scott & White Surgicare-Granbury
$3,150.00Published ratePediatric Surgery Centers, LLC
$2,353.00Published rateAustin Kidney Associates, P. A.
Austin Kidney Associates, P.A.
$1,542.00Published rateFairlawn Surgery Center, LLC
$853.00Published rateTranssouth Health Care PLLC, Transsouth Health Care PC
Transsouth Health Care, P.C.
$520.00Published rate
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See a sample payer proposalCPT 43240 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43240 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 43240 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 |
|---|---|---|
| 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) |
| 43240-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Transmural Drainage Of Pseudocyst (Includes Placement Of Transmural Drainage Catheter[S]/ Stent[S] When Performed And Endoscopic Ultrasound When Performed) (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 43240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43240 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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