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See a sample rate comparisonCPT 43245 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.
Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Dilation Of Gastric Outlet For
| 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 | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $654.99 national non-facility rate (2026) · View Medicare rates for 43245 |
| Medicaid Fee Schedule | $512.105 median of the 8 states in the free preview · View Medicaid rates for 43245 |
National average reimbursement for CPT 43245 by major payers:
$563.01
$617.83
$711.77
$329.84
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CPT 43245
5 of 25 sample ratesHigher to lower in this preview
Bayonet Point Surgery Center Ltd
$5,532.00Published rateSummit Surgical Associates LLC, Summit Surgical Center
Summit Surgical
$1,528.00Published rateLoveland Endoscopy Center, LLC, Skyline Endoscopy Center
Loveland Endoscopy Center LLC
$884.00Published rateDecatur Urology Surgery Center
$700.00Published rateAugusta Urology Surgicenter, LLC
$410.00Published rate
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See a sample payer proposalCPT 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 | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Transendoscopic Tube Or Cat Heter Placement |
| 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. |
| 43245-CPT | Moderate | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Dilation Of Gastric Outlet For |
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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