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 |
| Medicare Fee Schedule | View Medicare rates for 43243 |
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 | $1076.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $516.00 | 1306957485 - FAIRFAX COLON & RECTAL SURGERY CENTER, LLC | 510571797 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $2349.00 | 1821642661 - STEAMBOAT SURGERY CENTER, LLC | 834367630 - (CO) STEAMBOAT SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $1368.00 | 1396825386 - HUDSON VALLEY ENDOSCOPY CENTER, INC | 141800629 - (NY) HUDSON VALLEY ENDOSCOPY CENTER, INC. | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $544.00 | 1275516718 - PREMIER SURGICAL CENTER, INC | 200671644 - (ID) PREMIER SURGICAL CENTER INC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $2817.00 | 1508837899 - MEMORIAL HERMANN SURGERY CENTER NORTHWEST, LLP, MEMORIAL HERMANN SURGERY CENTER GREATER HEIGHTS | 200689650 - (TX) MEMORIAL HERMANN SURGERY CENTER NORTHWEST LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $2713.00 | 1225064736 - NMC SURGERY CENTER, L.P., THE SURGERY CENTER OF NACOGDOCHES | 752793512 - (TX) NMC SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $2345.00 | 1720161615 - MANKATO SURGICAL CENTER, L.L.C., MANKATO SURGERY CENTER | 411924647 - (MN) MANKATO SURGICAL CENTER, LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $1009.00 | 1023056090 - GAILEY EYE SURGERY-DECATUR LLC | 364542211 - (IL) GAILEY EYE SURGERYDECATUR LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $830.00 | 1720059785 - COOK CHILDREN'S MEDICAL CENTER, DODSON SURGERY CENTER | 752051646 - (TX) COOK CHILDRENS MEDICAL CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $1242.00 | 1356412894 - ROCKFORD ORTHOPEDIC SURGERY CENTER, LLC | 364513047 - (IL) ROCKFORD ORTHOPEDIC SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $661.00 | 1427052026 - SUMMIT ENDOSCOPY CENTER | 582508201 - (GA) SUMMIT ENDOSCOPY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $830.00 | 1043874621 - BROWNSVILLE SURGICENTER, LLC | 825464594 - (TX) BROWNSVILLE SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $900.00 | 1184897472 - LAKE COUNTRY ENDOSCOPY CENTER, LLC | 261572986 - (WI) LAKE COUNTRY ENDOSCOPY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43243 | $377.00 | 1023257300 - CAROLINA DIGESTIVE DISEASES, PA | 202989799 - (NC) CAROLINA DIGESTIVE DISEASES | NC | 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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