CPT 43251 Fee Schedule

Medicare rates as of October 2026

CPT 43251 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 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	51 - Multiple procedures 59 - Distinct Procedural Service
Complexity Level	Moderate
Medicare Fee Schedule	$545.77 national non-facility rate (2026) · View Medicare rates for 43251
Medicaid Fee Schedule	$428.35 median of the 8 states in the free preview · View Medicaid rates for 43251

National average reimbursement for CPT 43251 by major payers:

$496.01

BCBS / Anthem

$524.22

UnitedHealthcare

$605.03

Aetna

$354.18

Cigna

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CPT 43251

5 of 25 sample ratesHigher to lower in this preview

Physicians West Houston Surgical Center, LLC, Memorial Hermann Surgery Center Park Ten
TXAmbulatory Surgical Clinic/CenterNPI 1033586136Tax ID 37-1789833
$2,480.00Published rate
Central Jersey Ambulatory Surgical Center, LLC
Central Jersey Ambulatory Surgical Center LLC
NJAmbulatory Surgical Clinic/CenterNPI 1043297872Tax ID 22-3669777
$1,050.00Published rate
Lorain Surgery Center, LLC
Lorain Surgery Center LLC
OHAmbulatory Surgical Clinic/CenterNPI 1649250218Tax ID 20-1641777
$700.00Published rate
Discover Eye Surgery Center, LLC, Eye Surgery Center - The Cliffs
Discover Eye Surgery Center LLC
MOAmbulatory Surgical Clinic/CenterNPI 1861485138Tax ID 43-1909100
$508.00Published rate
Eyecare Surgery Center, LLC
Eyecare Surgery Center LLC
MSAmbulatory Surgical Clinic/CenterNPI 1821336371Tax ID 46-1073660
$266.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 43251 vs. Other Surgical Procedures on the Digestive System Codes

The table lists codes related to 43251. Select one to see its fee schedule.

Code	Complexity	Description
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
43257-CPT	Moderate	Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Incl Esophagus Stomach Either The Duodenum Andor Jejunum As Appropriate With Delivery Of Thermal Energy To The Muscle Of Lower Esophageal Sphincter Gastric

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43251. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 43251 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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