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See a sample rate comparisonCPT 43246 Fee Schedule
Medicare rates as of October 2026
CPT 43246 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
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 | GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $178.36 national non-facility rate (2026) · View Medicare rates for 43246 |
| Medicaid Fee Schedule | $153.94 median of the 8 states in the free preview · View Medicaid rates for 43246 |
National average reimbursement for CPT 43246 by major payers:
$284.12
BCBS / Anthem
$295.05
UnitedHealthcare
$319.17
Aetna
$346.15
Cigna
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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 table lists codes related to 43246. Select one to see its fee schedule.
| 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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