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: July 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	Esophagogastroduodenoscopy Procedures Endoscopy Procedures on the Esophagus
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

National average reimbursement for CPT 43248 by major payers:

$427.59

$431.76

$505.05

$296.64

Preview provider-level rates for...

For billing codeCPT 43248

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	43248	$1397.00	1528027026 - VIRGINIA BEACH AMBULATORY SURGERY CENTER	541448218 - (VA) VIRGINIA BEACH AMBULATORY SURGERY CENTER	VA	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$743.00	1255309803 - G S S C LTD PARTNERSHIP	680343818 - (CA) GSSC LTD PARTNERSHIP DBA GREATER SACRAMENTO SURGERY CENTER	CA	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$565.00	1225286354 - ASC DEVELOPMENT COMPANY, LLC	203405773 - (MD) ASC DEVELOPMENT COMPANY LLC	MD	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$1490.00	1477242154 - PLYMOUTH ORTHOPEDIC SURGERY CENTER LLC, PLYMOUTH ORTHOPEDIC SURGERY CENTER	883632673 - (MN) PLYMOUTH ORTHOPEDIC SURGERY CENTER LLC	MN	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$2701.00	1861825986 - VADNAIS HEIGHTS SURGERY CENTER LLC, VADNAIS HEIGHTS SURGERY CENTER	371866891	MN	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$415.00	1689188823 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC	593646134 - (FL) FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC	FL	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$629.00	1063935286 - CHESNUT INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY	821592877 - (WA) CLINIC 5C	WA	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$598.00	1871729111 - RIVERVIEW AMBULATORY SURGICAL CENTER, LLC	900456643 - (PA) RIVERVIEW AMBULATORY SURGICAL CE	PA	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$810.00	1790799047 - WATSONVILLE SURGEONS GROUP LLC, CENTRAL COAST SURGERY CENTER	770549602 - (CA) WATSONVILLE SURGEON'S GROUP INC	CA	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$479.00	1972549491 - UNION CITY ASC LLC, SUMMIT ENDOSCOPY CENTER	621625423	TN	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$1300.00	1508400920 - NAZARETH ENDOSCOPY CENTER, LLC	824072967 - (PA) NAZARETH ENDOSCOPY CENTER LLC	PA	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$1200.00	1285936641 - RIVERS EDGE AESTHETIC SURGERY, LLC	271645468 - (SD) RIVERS EDGE AESTHETIC SURGERY LLC	SD	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$725.00	1023160553 - ALBANY SURGERY CENTER, LLP	582437516 - (GA) ALBANY SURGERY CENTER LLP	GA	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$1316.00	1942230024 - LUTHERVILLE ENDOSCOPY CENTER LLC	823193901	MD	Ambulatory Surgical Clinic/Center (261QA1903X)
United	43248	$1276.00	1548203888 - NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC, THE ORTHOPEDIC SURGERY CENTER OF ARIZONA	202684773 - (AZ) NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC	AZ	Ambulatory Surgical Clinic/Center (261QA1903X)
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 43248 vs. Other Endoscopy Procedures on the Esophagus Codes

The CPT 43248 code is part of the Esophagogastroduodenoscopy Procedures services used for Endoscopy Procedures on the Esophagus. 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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