CPT 43245 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $557.65 Physician Fee Schedule |
National average reimbursement for CPT 43245 by major payers:
$563.01
$617.83
$711.77
$871.21
| 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 43245 | ||||||
United | 43245 | $977.00 | 1639669476 - UCHEALTH AMBULATORY SURGERY CENTERS, LONGS PEAK SURGERY CENTER, LLC | 383984888 - (CO) UCHEALTH AMBULATORY SURGERY CENTERS | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $1528.00 | 1740371665 - SUMMIT SURGICAL ASSOCIATES LLC, SUMMIT SURGICAL CENTER | 954810282 - (CA) SUMMIT SURGICAL | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $515.00 | 1578536686 - DCA DIAGNOSTICS, LLC | 161710235 - (GA) DCA DIAGNOSTICS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $1937.00 | 1720023484 - SPALDING TRIANGLE SURGERY CENTER, LLC, SPALDING TRIANGLE SURGERY CENTER | 760769099 - (CA) SPALDING TRIANGLE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $1276.00 | 1184687386 - DIGESTIVECARE, LLC, DIGESTIVECARE ENDOSCOPY UNIT | 311108485 - (OH) DIGESTIVE CARE, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $1358.00 | 1891717195 - CENTER FOR PAIN MANAGEMENT LLC, TUCSON UROLOGIC SURGERY CENTER | 830962530 - (AZ) CENTER FOR PAIN MANAGEMENT LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $890.00 | 1396700159 - DOCTORS SAME DAY SURGERY CENTER, LTD | 621614361 - (FL) DOCTORS SAME DAY SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $1770.00 | 1346468253 - FAIRVIEW MAPLE GROVE SURGERY CENTER, LLC | 208335586 - (MN) FAIRVIEW MAPLE GROVE SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $341.00 | 1710032842 - MSC AMBULATORY SURGICAL CENTER | 202155076 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $2382.00 | 1669446852 - VOORHEES NJ ENDOSCOPY ASC LLC, THE ENDO CENTER AT VOORHEES | 510446274 - (NJ) THE VOORHEES NJ ENDOSCOPY ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $829.00 | 1598744732 - MIDWEST EYE SURGERY CENTER, LLC | 470831193 - (NE) MIDWEST EYE SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $1449.00 | 1881375319 - MIDWEST SURGERY CENTER, LLC, MIDWEST SURGERY CENTER - EAGAN | 411537436 - (MN) MIDWEST SURGERY CENTER | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $934.00 | 1548223068 - COLUMBIA SURGICARE OF AUGUSTA, LTD | 621671906 - (GA) COLUMBIA SURGICARE OF AUGUSTA LTD | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $555.00 | 1972030161 - ADVANCED VISION SURGERY CENTER LLC | 820697854 - (CO) ADVANCED VISION SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43245 | $1322.00 | 1942278692 - FOLSOM OUTPATIENT SURGERY CENTER, LP, FOLSOM SURGERY CENTER | 202468634 - (CA) FOLSOM OUTPATIENT SURGERY CENTER LP | CA | 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 43245 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43245 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 43245 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) |
| 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) |
| 43245-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Directed Placement Of Percutaneous Gastrostomy Tube (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 43245. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43245 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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