CPT 43248 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| CMS | $393.01 Physician Fee Schedule |
National average reimbursement for CPT 43248 by major payers:
$427.59
$431.76
$505.05
$610.23
| 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 43248 | ||||||
United | 43248 | $1050.00 | 1649416231 - CLINTON PARTNERS, LLC, SURGERY CENTER OF CLINTON TOWNSHIP | 202236024 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $957.00 | 1124086608 - LUTHERAN CAMPUS ASC LLC, THE SURGERY CENTER AT LUTHERAN | 20749532 - (CO) LUTHERAN CAMPUS ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $1233.00 | 1902807159 - SURGERY CENTER OF SCOTTSDALE, LLC, MOUNTAIN VIEW SURGERY CENTER OF SCOTTSDALE | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | 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 | $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 | $1258.00 | 1740794973 - EPIC ASC, LLC, EPIC SURGERY CENTER | 611859657 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $334.00 | 1063701977 - NEW VISION SURGICAL CENTER, LLC | 270354247 - (FL) NEW VISION SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $890.00 | 1518920040 - COUNTRYSIDE SURGERY CENTER, LTD | 752400186 - (FL) COUNTRYSIDE SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $2901.48 | 1447221486 - ORTHOPAEDIC OUTPATIENT SURGERY CENTER, LLC | 421508092 - (IA) ORTHOPAEDIC OUTPATIENT SURGERY CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $2382.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $1354.00 | 1245288257 - SURGICAL CENTER OF GREENSBORO, LLC | 631251243 - (NC) SURGICAL CENTER OF GREENSBORO LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $670.00 | 1154873594 - AMERICAN ACCESS CARE OF PENNSYLVANIA ASC LLC | 814056190 - (PA) AMERICAN ACCESS CARE OF PENNSYLVANIA ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $487.00 | 1740448711 - TREVOSE SPECIALTY CARE SURGICAL CENTER, LLC | 262420083 - (PA) TREVOSE SPECIALTY CARE SURGICAL CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43248 | $646.00 | 1104465012 - EVERGREEN EYE CENTER, PLLC | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | 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 | 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 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 | Esophagogastroduodenoscopy Flexible Transoral; With Insertion Of Guide Wire Followed By Passage Of Dilator(S) Through Esophagus Over Guide Wire (Revised 01/01/2014) |
| 43249-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Transendoscopic Balloon Dilation Of Esophagus(Less Than 30 Mm Diameter) (Revised 01/01/2014) |
| 43250-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Removal Of Tumor(S) Polyp(S) Or Other Lesion(S) By Hot Biopsy Forceps (Revised 01/01/2015) |
| 43255-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Control Of Bleeding Any Method (Revised 01/01/2014) |
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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