CPT 43241 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $136.83 Physician Fee Schedule |
National average reimbursement for CPT 43241 by major payers:
$200.49
$199.02
$219.32
$243.23
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 43241 | ||||||
United | 43241 | $415.00 | 1447748470 - CTS SURGICAL ASSOCIATES LLC, CEDAR TREE SURGICAL CENTER | 825298503 | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $1657.00 | 1710688627 - BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | 922359229 - (KY) BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $928.00 | 1801825880 - SURGERY CENTER AT RIVER ROAD, LLC, AESTHETIC SURGERY AT HACIENDA DEL SOL | 760824670 - (AZ) SURGERY CENTER AT RIVER ROAD, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $511.00 | 1750974176 - NCBH OUTPATIENT ENDOSCOPY CENTER, L.L.C., WAKE FOREST BAPTIST HEALTH OUTPATIENT ENDOSCOPY - QUAKER LANE | 270668137 - (NC) NCBH OUTPATIENT ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $997.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $2382.00 | 1730410697 - SURGICAL SPECIALISTS AT PRINCETON LLC | 270749140 - (NJ) SURGICAL SPECIALISTS AT PRINCE | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $840.00 | 1962007757 - SURGERY CENTER AT GROVE CREEK, LLC | 854085559 - (UT) SURGERY CENTER AT GROVE CREEK LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $780.00 | 1518549393 - IREDELL PHYSICIAN NETWORK, LLC, IREDELL SURGERY AT MOORESVILLE ASC | 263853529 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $530.00 | 1699767210 - SOUTHERN OKLAHOMA SURGICAL CENTER INC | 731205988 - (OK) SOUTHERN OKLAHOMA SURGICAL CENTER, INC. | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $1137.00 | 1710924899 - DMG SURGICAL CENTER LLC, SURGICAL CENTER OF DUPAGE MEDICAL GROUP | 371474161 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $934.00 | 1811978356 - WESTSIDE SURGERY CENTER, LLC | 900082030 - (OR) WESTSIDE SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $489.00 | 1104199413 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC SUN CITY | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $675.00 | 1215489182 - CORONADO SURGERY CENTER LLC | 814244748 - (AZ) CORONADO SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $3024.00 | 1174969372 - AURORA GI ASC LLC, WISCONSIN DIGESTIVE HEALTH CENTER | 461848055 - (WI) AURORA GI ASC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43241 | $117.77 | 1538346200 - IRTAZA KHAN | 350593390 - DEACONESS HOSPITAL INC | IL | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 43241 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43241 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 43241 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 |
|---|---|---|
| 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) |
| 43241-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Insertion Of Intraluminal Tube Or Catheter (Revised 01/01/2014) |
| 43242-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Transendoscopic Ultrasound-Guided Intramural Or Transmural Fine Needle Aspiration/Biopsy(S) (Includes Endoscopic Ultrasound Examination Of Theesophagus Stomach And Either The Duodenum Or A Surgically Altered Stomach Where The Jejunum Is Examined Distal To The Anastomosis) (Revised 01/01/2014) |
| 43243-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Injection Sclerosis Of Esophageal/Gastric Varices (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 43241. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43241 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43241) and we'll show you how you compare in 15 minutes or less.