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See a sample rate comparisonCPT 43252 Fee Schedule
Last Verified: October 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.
Digestive Tract Scope Exam, An Exam Of The Digestive Tract Using A Scope. An Endoscope (A Flexible Tube With Lenses And A Light) Enables One To See The Esophagus (Food Tube) And Stomach.
| 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 SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $377.10 national non-facility rate (2026) · View Medicare rates for 43252 |
| Medicaid Fee Schedule | $282.08 median of the 8 states in the free preview · View Medicaid rates for 43252 |
National average reimbursement for CPT 43252 by major payers:
$567.72
$462.80
$464.69
$319.13
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CPT 43252
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC, Aurora Pleasant Prairie Ambulatory Surgery Center
Aurora Surgery Centers LLC
$3,024.00Published rateSt. Mary'S Surgical Center LLC, St. Mary'S Surgical Center
St Marys Surgical Center LLC
$1,585.00Published rateBsc Reid Park LLC
$947.00Published rateSouthwest Ohio Pain Management LLC
Southwest Ohio Pain Management
$658.00Published rateSurgical Center Of Central Florida, LLC
Surgical Center Of Central Florida LLC
$431.00Published rate
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See a sample payer proposalCPT 43252 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43252 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 43252 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 |
| 43252-CPT | Moderate | Digestive Tract Scope Exam, An Exam Of The Digestive Tract Using A Scope. An Endoscope (A Flexible Tube With Lenses And A Light) Enables One To See The Esophagus (Food Tube) And Stomach. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43252. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43252 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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