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See a sample rate comparisonCPT 43248 Fee Schedule
Medicare rates as of October 2026
CPT 43248 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 Insertion Of Guide Wire Fol Lowed By
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $457.93 national non-facility rate (2026) · View Medicare rates for 43248 |
| Medicaid Fee Schedule | $359.455 median of the 8 states in the free preview · View Medicaid rates for 43248 |
National average reimbursement for CPT 43248 by major payers:
$427.59
BCBS / Anthem
$431.76
UnitedHealthcare
$505.05
Aetna
$296.64
Cigna
Compare published rates across providers.
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CPT 43248
5 of 25 sample ratesHigher to lower in this preview
Vadnais Heights Surgery Center LLC, Vadnais Heights Surgery Center
$2,701.00Published rateNazareth Endoscopy Center, LLC
Nazareth Endoscopy Center LLC
$1,300.00Published rateClinton Partners, LLC, Surgery Center Of Clinton Township
$1,050.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$565.00Published rateMidsouth Interventional Pain Institute, LLC
Midsouth Interventional Pain Institute LLC
$400.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 43248 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43248. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 43248-CPT | Moderate | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Insertion Of Guide Wire Fol Lowed By |
| 43249-CPT | Moderate | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Balloon Dilation Of Esophag Us (Less Than |
| 43250-CPT | Moderate | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Removal Of Tumor(S) Polyp( S) Or Other |
| 43255-CPT | Moderate | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Control Of Bleeding Any Me Thod |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43248. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43248 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are five-digit alphanumeric codes used by healthcare providers to report medical, surgical, and diagnostic services to entities such as health insurance companies. They are crucial for standardizing medical billing, record-keeping, and understanding the specific services rendered.
To find the cost of a specific medical procedure or service, you can use online fee schedule lookup tools. Payerprice offers a tool where you can search with a CPT code and your specific location to get estimated costs. It's also recommended to contact your insurance provider or healthcare facility for the most accurate and personalized cost information.
Payerprice is a platform that provides a fee schedule lookup tool allowing users to search for healthcare costs using CPT codes and specific locations, often reflecting commercial or market rates. CMS (Centers for Medicare & Medicaid Services) data primarily pertains to prices for services covered under Medicare and Medicaid programs. While CMS data is publicly available, it may not accurately reflect the prices you would pay with private insurance or the specific rates charged in your local market for all services. For personalized cost information based on specific CPT codes and your location, Payerprice is a recommended resource.
The prices provided by fee schedule lookup tools, including Payerprice, are typically estimates or average charges for a service. The final amount you will pay can vary significantly based on your specific health insurance plan, deductibles, co-pays, co-insurance, whether the provider is in-network or out-of-network, and any additional services or complications. Always confirm the final cost with your insurance provider and the healthcare facility directly.
Payerprice offers a user-friendly fee schedule lookup tool that allows you to search for healthcare costs specifically by CPT code and your geographic location. This can provide more granular and localized pricing insights compared to general price estimates or data primarily focused on government programs like Medicare (CMS). For consumers seeking to understand potential out-of-pocket costs based on their specific situation, Payerprice can be a valuable resource for price transparency.