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See a sample rate comparisonCPT 43250 Fee Schedule
Last Verified: September 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 Removal Of Tumor(S) Polyp( S) Or Other
| 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 |
| Medicare Fee Schedule | View Medicare rates for 43250 |
| Medicaid Fee Schedule | View Medicaid rates for 43250 |
National average reimbursement for CPT 43250 by major payers:
$445.07
$472.41
$544.26
$308.89
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CPT 43250
5 of 25 sample ratesHigher to lower in this preview
Mercy Terrace Hill Surgery Center, LLC, Mercy River Hills Surgery Center
Mercy Terrace Hill Surgery Center LLC
$2,956.00Published rateAdvanced Surgery Center Of Metairie LLC
Advanced Surgery Center Of Metairie
$1,276.00Published rateTidelands Health Asc LLC, Tidelands Health Surgery Center At The Market Common
Tidelands Health Asc LLC
$788.00Published rateKokomo Ambulatory Surgery Center
$656.00Published rateCenter For Advanced Eye Surgery, Ltd
Center For Advanced Eye Surgery Ltd
$422.00Published rate
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See a sample payer proposalCPT 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 | 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 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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