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See a sample rate comparisonCPT 43243 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.
Exam Of Digestive Tract, Exam Using A Scope (Endoscope) To View The Esophagus Stomach And Part Of The Intestines. Enlarged Veins (Varices) In The Esophagus And Stomach Are Treated At This Time.
| 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 | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $209.09 national non-facility rate (2026) · View Medicare rates for 43243 |
| Medicaid Fee Schedule | $189.26 median of the 8 states in the free preview · View Medicaid rates for 43243 |
National average reimbursement for CPT 43243 by major payers:
$318.22
$335.08
$347.21
$398.65
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CPT 43243
5 of 25 sample ratesHigher to lower in this preview
South Suburban Surgical Suites, LLC, South Suburban Surgical Suites
South Suburban Surgical Suites LLC
$2,947.00Published rateRockford Orthopedic Surgery Center, LLC
$1,242.00Published rateLake Country Endoscopy Center, LLC
Lake Country Endoscopy Center LLC
$900.00Published rateSummit Endoscopy Center
$661.00Published rateCarolina Digestive Diseases, PA
Carolina Digestive Diseases
$377.00Published rate
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See a sample payer proposalCPT 43243 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43243 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 43243 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 |
|---|---|---|
| 43241-CPT | Moderate | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Transendoscopic Tube Or Cat Heter Placement |
| 43242-CPT | Moderate | Endoscopic Procedure, Upper Gastrointestinal Endoscopy Including Esophagus Stomach And Either The Duodenum And/Or Jejunum As Appropriate; With Transendoscopic Ultrasound-Guided Intramural Or Transmural Fine Needle Aspiration/Biopsy(S)(Includes Endoscopic Ultrasound Examination Of The Esophagus Stomach And Either The Duodenum And/Or Jejunum As Appropriate) |
| 43243-CPT | Moderate | Exam Of Digestive Tract, Exam Using A Scope (Endoscope) To View The Esophagus Stomach And Part Of The Intestines. Enlarged Veins (Varices) In The Esophagus And Stomach Are Treated At This Time. |
| 43244-CPT | Moderate | Exam Of Digestive Tract, Exam Using A Scope (Endoscope) To View The Esophagus Stomach And Part Of The Intestines. Enlarged Veins (Varices) In The Esophagus And Stomach Are Treated At This Time. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43243. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43243 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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