CPT 43250 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 • 59 - Distinct Procedural Service • SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| CMS | $426.97 Physician Fee Schedule |
National average reimbursement for CPT 43250 by major payers:
$445.07
$472.41
$544.26
$668.47
| 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 43250 | ||||||
United | 43250 | $489.00 | 1326089715 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $1391.00 | 1376774208 - DIGESTIVE DISEASES DIAGNOSTIC & TREATMENT CENTER LLC | 261319443 - (NY) DIGESTIVE DISEASES DIAGNOSTIC TREATMENT CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $825.00 | 1497745178 - SURGERY CENTER, DBA SAWTOOTH SURGERY CENTER | 823348107 - (ID) SURGERY CENTER | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $585.00 | 1023115078 - MAIN LINE PA ENDOSCOPY ASC LP, MAIN LINE ENDOSCOPY CENTER MALVERN | 205301211 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $350.00 | 1053417402 - KEYSTONE KIDNEY ASSOCIATES, PC | 232470181 - (PA) KEYSTONE KIDNEY ASSOCIATES PC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $656.00 | 1609376409 - KOKOMO AMBULATORY SURGERY CENTER | 823461246 - (IN) KOKOMO AMBULATORY SURGERY CENTER | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $564.00 | 1780604694 - CLEARVIEW SURGERY CENTER INC | 202828714 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $788.00 | 1194344606 - TIDELANDS HEALTH ASC LLC, TIDELANDS HEALTH SURGERY CENTER AT THE MARKET COMMON | 611930163 - (SC) TIDELANDS HEALTH ASC LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $1181.00 | 1427282771 - UPSTATE ORTHOPEDICS AMBULATORY SURGERY CENTER LLC, UPSTATE ORTHOPEDICS ASC | 770711020 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $390.00 | 1326494147 - CENTER FOR SPINE & PAIN MEDICINE PC, CSPM GAINESVILLE ASC | 341976829 - CENTER FOR SPINE AND PAIN MEDICI | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $1528.00 | 1558401299 - SAN GABRIEL VALLEY SURGICAL CENTER LP | 752965449 - (CA) SAN GABRIEL VALLEY SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $1155.00 | 1780021188 - ENDOSCOPY CENTER OF NIAGARA, LLC | 453630889 - (NY) ENDOSCOPY CENTER OF NIAGARA LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $2025.00 | 1013493824 - ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO, LURIE CHILDREN'S SURGERY CENTER IN NORTHBROOK | 362170833 - ANN & ROBERT H LURIE CHILDRENS HOSPITAL OF CHICAGO | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $544.00 | 1275516718 - PREMIER SURGICAL CENTER, INC | 200671644 - (ID) PREMIER SURGICAL CENTER INC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43250 | $750.00 | 1376501064 - SOUTH CENTRAL SURGICAL CENTER, LLC, CENTER FOR SPECIALTY CARE | 411952256 - (MN) SOUTH CENTRAL SURGICAL CENTER LLC | MN | 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 43250 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43250 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 43250 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 43250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43250 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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