What is CPT Code 43248?

CPT Code 43248 describes an Esophagogastroduodenoscopy Flexible Transoral; With Insertion Of Guide Wire Followed By Passage Of Dilator(S) Through Esophagus Over Guide Wire.

What factors affect fee schedules?

Factors affecting fee schedules include government-set Medicare & Medicaid rates, negotiated private insurance rates, geographic location (e.g., higher costs in urban areas), and provider type (e.g., hospital vs. private practice).

How can PayerPrice help with CPT 43248 fee schedules?

PayerPrice provides access to negotiated rates that insurers publish under federal transparency rules, allowing users to benchmark rates, prospect for new business, and integrate real-time payer data into workflows for codes like CPT 43248.

What is the complexity level of CPT 43248?

CPT 43248 is considered a moderate-level complexity code, often involving multiple diagnoses or prescription management.

What is a CPT code and why is it important?

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.

How can I find the cost of a specific medical procedure or service?

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.

What is the difference between Payerprice and CMS data when looking up healthcare costs?

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.

Is the price I find using a fee schedule lookup tool the final amount I will pay?

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.

Why should I use Payerprice to look up healthcare costs instead of other sources?

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.

CPT 43248 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 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	None 51 - Multiple procedures SG - Scene to Hospital ESRD facility
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 43248
Medicaid Fee Schedule	View Medicaid rates for 43248

National average reimbursement for CPT 43248 by major payers:

$427.59

$431.76

$505.05

$296.64

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 43248.

CPT 43248

5 of 25 sample ratesHigher to lower in this preview

Vadnais Heights Surgery Center LLC, Vadnais Heights Surgery Center
MNAmbulatory Surgical Clinic/CenterNPI 1861825986Tax ID 37-1866891
$2,701.00Published rate
Nazareth Endoscopy Center, LLC
Nazareth Endoscopy Center LLC
PAAmbulatory Surgical Clinic/CenterNPI 1508400920Tax ID 82-4072967
$1,300.00Published rate
Clinton Partners, LLC, Surgery Center Of Clinton Township
MIAmbulatory Surgical Clinic/CenterNPI 1649416231Tax ID 20-2236024
$1,050.00Published rate
Asc Development Company, LLC
Asc Development Company LLC
MDAmbulatory Surgical Clinic/CenterNPI 1225286354Tax ID 20-3405773
$565.00Published rate
Midsouth Interventional Pain Institute, LLC
Midsouth Interventional Pain Institute LLC
TNAmbulatory Surgical Clinic/CenterNPI 1164734232Tax ID 27-2910652
$400.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 43248 vs. Other Surgical Procedures on the Digestive System Codes

The CPT 43248 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 43248 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
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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CPT 43248 Fee Schedule

Vadnais Heights Surgery Center LLC, Vadnais Heights Surgery Center

Nazareth Endoscopy Center, LLC

Clinton Partners, LLC, Surgery Center Of Clinton Township

Asc Development Company, LLC

Midsouth Interventional Pain Institute, LLC