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See a sample rate comparisonCPT 43246 Fee Schedule
Last Verified: September 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 Directed Placement Of Percu Taneous
| 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 GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43246 |
| Medicaid Fee Schedule | View Medicaid rates for 43246 |
National average reimbursement for CPT 43246 by major payers:
$284.12
$295.05
$319.17
$346.15
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CPT 43246
5 of 25 sample ratesHigher to lower in this preview
Precision Ambulatory Surgery Center LLC
$1,995.00Published ratePeninsula Surgery Center, LLC
$1,150.00Published rateRenaissance Surgery Center, LLC
$830.00Published rateBuckeye South LLC, Buckeye Surgery Center
Buckeye South LLC
$509.00Published rateIndiana Skin Cancer Ambulatory Surgical Center LLC
$330.00Published rate
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See a sample payer proposalCPT 43246 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43246 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 43246 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. |
| 43246-CPT | Moderate | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Directed Placement Of Percu Taneous |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43246. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43246 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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