CPT 43243 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 | $227.72 Physician Fee Schedule |
National average reimbursement for CPT 43243 by major payers:
$318.22
$335.08
$347.21
$406.47
| 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 43243 | ||||||
United | 43243 | $556.00 | 1639237092 - MUSCULOSKELETAL AMBULATORY SURGERY CENTER INC, THE SURGERY CENTER AT POINTE WEST | 650829385 - (FL) MUSCULOSKELETAL AMBULATORY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $2199.00 | 1508500273 - GASTROINTESTINAL ASSOCIATES ENDOSCOPY CENTER, LLC | 262157335 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $375.00 | 1063437994 - TRI-CITIES ENDOSCOPY CENTER PC, THE CENTER FOR DIGESTIVE WELLNESS | 621867929 - (TN) TRICITIES ENDOSCOPY CENTER PC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $415.00 | 1013999580 - INTEG HEALTH SYSTEM, P.C., BLOOMINGTON SURGERY CENTER | 352045236 - (IN) INTEG HEALTH SYSTEM PC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $196.71 | 1356009468 - MELISSA MCKINNEY | 350593390 - DEACONESS HOSPITAL INC | KY | Certified Registered Nurse Anesthetist (367500000X) |
United | 43243 | $428.13 | 1841647260 - RICHARD UY | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 43243 | $465.00 | 1255911970 - PINNACLE SURGERY CENTER | 842367400 - (LA) PINNACLE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $750.00 | 1619935483 - OUTPATIENT SURGERY CENTER OF HILTON HEAD | 611409045 - (SC) OUTPATIENT SURGERY CENTER OF HILTON HEAD | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $1528.00 | 1841605318 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER, LLC, FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER-CITRUS PARK | 593646134 - (FL) FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $1350.00 | 1407317019 - RIVERSIDE SURGICAL CENTER OF MEADOWLANDS, LLC, RIVERSIDE SURGICAL CENTER OF RUTHERFORD | 832735771 - (NJ) RIVERSIDE SURGICAL CENTER OF MEADOWLANDS LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $428.13 | 1467042804 - MARIA KLOPFENSTEIN | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
United | 43243 | $527.00 | 1528622321 - PREMIER-COVENANT ASTC LLC, PREMIER AMBULATORY SURGERY CENTER | 834550993 - (TN) PREMIERCOVENANT ASTC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $564.00 | 1174502272 - ENDOSCOPY CENTER OF TOPEKA LP, THE ENDOSCOPY AND SURGERY CENTER OF TOPEKA | 621512368 - (KS) THE ENDOSCOPY CENTER OF TOPEKA L | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $880.00 | 1124068549 - CROWN VALLEY SURGERY CENTER | 454125214 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $629.00 | 1467883496 - KILLER BEES LLC, BLUEGRASS SURGERY AND LASER CENTER | 201075292 | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 |
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CPT 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 | 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) |
| 43244-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Band Ligation 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 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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