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See a sample rate comparisonCPT 43249 Fee Schedule
Medicare rates as of October 2026
CPT 43249 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 Balloon Dilation Of Esophag Us (Less Than
| 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 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $1,180.39 national non-facility rate (2026) · View Medicare rates for 43249 |
| Medicaid Fee Schedule | $921.77 median of the 8 states in the free preview · View Medicaid rates for 43249 |
National average reimbursement for CPT 43249 by major payers:
$916.70
BCBS / Anthem
$1,043.79
UnitedHealthcare
$1,224.16
Aetna
$324.19
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43249.
CPT 43249
5 of 25 sample ratesHigher to lower in this preview
Overlook Hospital
Atlantic Health System Inc
$2,103.21Published rateDavid Carroll
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$1,726.00Published rateWade Sexton
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$1,692.16Published rateDaniela Londono
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$1,467.10Published rateAutumn Moon
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$1,438.33Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 43249 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43249. 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 |
| 43251-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 |
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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Frequently Asked Questions
To find out the estimated cost of a specific medical procedure, you will typically need the CPT (Current Procedural Terminology) code for that procedure and your specific location. For a comprehensive search, we recommend using a specialized tool like Payerprice's fee schedule lookup tool, which allows you to search with a CPT code and location to find relevant pricing information. It's also advisable to contact your insurance provider and the healthcare facility directly for the most accurate estimate tailored to your specific situation and coverage.
CPT (Current Procedural Terminology) codes are a standardized set of five-digit alphanumeric codes used by medical professionals to describe medical, surgical, and diagnostic services and procedures. They are essential for billing, processing insurance claims, and ensuring clear communication about the specific services a patient has received. Understanding the CPT code for your procedure is key to researching its cost.
Prices for the same medical procedure can vary significantly due to a multitude of factors. These include the specific healthcare provider or facility (e.g., hospital vs. outpatient clinic), geographical location, the patient's insurance plan and negotiated rates with providers, the complexity of the case, and whether the provider is in-network or out-of-network. Using tools like Payerprice can help you compare costs for specific procedures in different locations and by different providers.
Fee schedules, which list the maximum fees an insurance plan or provider might charge for specific medical procedures, can be challenging for the average consumer to access directly. However, you can find searchable fee schedule information for specific CPT codes and locations using specialized online tools. For instance, Payerprice offers a fee schedule lookup tool where you can input a CPT code and your specific location to access relevant pricing data, helping you to understand potential costs.
To effectively use Payerprice's fee schedule lookup tool, you primarily need two pieces of information: the CPT (Current Procedural Terminology) code for the specific medical procedure or service you are interested in, and your specific geographical location (e.g., ZIP code or city and state). These details allow the tool to provide localized and relevant pricing information based on its database.