CPT 43247 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43247 |
National average reimbursement for CPT 43247 by major payers:
$397.34
$424.25
$489.38
$585.80
| 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 43247 | ||||||
United | 43247 | $549.64 | 1891741344 - SURENDER RASTOGI | 452548322 - MEDICAL ASSOCIATES OF ENGLEWOOD PC | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $376.67 | 1043665334 - SIDRAH RAFIQ | 237155946 - (NJ) RUTGERS HEALTHRWJ PRIMARY MEDICINE GROUP | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $482.60 | 1124076393 - ISAAK HALEGOUA | 223431049 - (NJ) CAPITAL HEALTH-EAST TRENTON INC | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $246.69 | 1154689156 - SHIPRA SHAH | 863536977 - (NJ) SHAH PRIMARY CARE | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $108.04 | 1629395629 - EUGENE FESTA | 832332326 - (NJ) REJUVENATION CENTER FOR MIND AND BODY | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $794.50 | 1467628255 - SARA ALI | 223316007 - BARNABAS HEALTH MEDICAL GROUP P C | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $130.05 | 1114032059 - NATALIE JOHNSON | 221487166 - (NJ) EAST ORANGE GENERAL HOSPITAL | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $1271.31 | 1871523910 - KAVITA SABNANI- NAGELLA | 223487984 - SUMMIT MEDICAL GROUP, P.A. | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $1336.63 | 1679607212 - JAN MRANI | 391028081 - BELOIT HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $308.20 | 1467541755 - DERRICK DESILVA | 475278841 - (NJ) DERRICK M DESILVA JR MD LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $148.88 | 1437144979 - VINUTHA RAJ | 651260308 - (NJ) JERSEY MEDICAL ASSOCIATES INC | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $567.28 | 1467832949 - SYEDA HUSSAIN | 596014973 - (FL) SOUTH BROWARD HOSPITAL DISTRICT | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $256.83 | 1548746225 - SHATHA ABUDAMOUS | 871440782 - (NJ) BETHANY CLINIC PC | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $427.04 | 1033682729 - LAUREN FERGES | 223630807 - (NJ) CENTRAL JERSEY INTERNAL MEDICINE ASSOCIATES, P.A. | NJ | Internal Medicine Physician (207R00000X) |
United | 43247 | $246.69 | 1851547889 - BINGHUA ZHU | 455037097 - (NJ) ICARE INTERNAL MEDICINE, LLC | NJ | Internal Medicine Physician (207R00000X) |
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 43247 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43247 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 43247 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 |
|---|---|---|
| 43215-CPT | Moderate | Esophagoscopy Flexible Transoral; With Removal Of Foreign Body(S) (Revised 01/01/2015) |
| 43216-CPT | Moderate | Esophagoscopy Flexible Transoral; With Removal Of Tumor(S) Polyp(S) Or Other Lesion(S) By Hot Biopsy Forceps (Revised 01/01/2015) |
| 43217-CPT | Moderate | Esophagoscopy Flexible Transoral; With Removal Tumor(S) Polyp(S) Or Other Lesion(S) By Snare Technique (Revised 01/01/2014) |
| 43247-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Removal Of Foreign Body(S) (Revised 01/01/2015) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43247. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43247 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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