CPT 43249 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 • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $991.10 Physician Fee Schedule |
National average reimbursement for CPT 43249 by major payers:
$916.70
$1,043.79
$1,224.16
$1,512.16
| 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 43249 | ||||||
United | 43249 | $1969.31 | 1457345910 - BRADLEY SMITH | 561079264 - EMERGEORTHO, P.A. | NC | Orthopaedic Surgery Physician (207X00000X) |
United | 43249 | $1438.33 | 1396447462 - PRISCILLA LAMBERTI | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Acute Care Nurse Practitioner (363LA2100X) |
United | 43249 | $1438.33 | 1073249017 - SAMANTHA KLEBOWSKI | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Gerontology Nurse Practitioner (363LG0600X) |
United | 43249 | $1692.16 | 1316980626 - ELIZABETH HAYNES | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | NY | Hematology (Internal Medicine) Physician (207RH0000X) |
United | 43249 | $1692.16 | 1629117916 - MARILIN ROSA | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Cytopathology Physician (207ZC0500X) |
United | 43249 | $1467.10 | 1548748395 - DANIELA LONDONO | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Gerontology Nurse Practitioner (363LG0600X) |
United | 43249 | $1467.10 | 1447416748 - MICHAEL HAUK | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Medical Physician Assistant (363AM0700X) |
United | 43249 | $1467.10 | 1619683281 - SARAH MALATESTA | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Nurse Practitioner (363L00000X) |
United | 43249 | $1726.00 | 1457467243 - MASOUMEH REZAEI | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Anatomic Pathology Physician (207ZP0101X) |
United | 43249 | $1467.10 | 1164930616 - KAELA BACON | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 43249 | $1726.00 | 1811341977 - ABU-SAYEEF MIRZA | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Hematology & Oncology Physician (207RH0003X) |
United | 43249 | $1438.33 | 1467968974 - NOELIA SALMERON | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Family Nurse Practitioner (363LF0000X) |
United | 43249 | $1438.33 | 1730617531 - KATHLEEN CUNNINGHAM | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 43249 | $1467.10 | 1720699671 - JESSICA COLLERA | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Adult Health Nurse Practitioner (363LA2200X) |
United | 43249 | $1467.10 | 1013194083 - MELISSA CLINTON | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Surgical Physician Assistant (363AS0400X) |
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 43249 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43249 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 43249 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) |
| 43251-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Removal Of Tumor(S) Polyp(S) Or Other Lesion(S) By Snare Technique (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 43249. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43249 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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