CPT 43253 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43253 |
National average reimbursement for CPT 43253 by major payers:
$354.63
$369.10
$388.30
$456.59
| 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 43253 | ||||||
United | 43253 | $420.00 | 1073601332 - LISA RENFRO SURGERY CENTER LLC | 43612312 - (MD) LISA RENFRO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $491.00 | 1174859516 - HERMITAGE TN ENDOSCOPY ASC, LLC, ASSOCIATED ENDOSCOPY | 270986942 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $472.00 | 1619923661 - DELTA ENDOSCOPY CENTER, P.C. | 640903701 - (MS) DELTA ENDOSCOPY CENTER PC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $398.00 | 1043282775 - BALTIMORE ENDOSCOPY ASC LLC, GASTROINTESTINAL DIAGNOSTIC CENTER | 621760110 - (MD) BALTIMORE ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $650.00 | 1326388000 - SOUTHEASTERN ORTHOPAEDICS SURGERY CENTER | 352467951 - (GA) SOUTHEASTERN ORTHOPAEDICS SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $1276.00 | 1295060069 - TIMONIUM SURGERY CENTER, LLC | 270399689 - (MD) TIMONIUM SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $503.00 | 1154301240 - ENDOSCOPY CENTER OF WASHINGTON DC LP, THE ENDOSCOPY CENTER OF WASHINGTON, D.C. | 621543524 - (DC) ENDOSCOPY CENTER OF WASHINGTON DC LP | DC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $803.00 | 1558050831 - BAPTIST HEALTH SURGERY CENTER, LLC | 650663357 - (FL) BAPTIST HEALTH SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $1252.00 | 1225452303 - MARTHA JEFFERSON HOSPITAL, MARTHA JEFFERSON OUTPATIENT SURGERY CENTER | 540261840 - (VA) MARTHA JEFFERSON HOSPITAL | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $715.00 | 1629713730 - PG COUNTY ENDOSCOPY CENTER LLC | 881766792 - (MD) PG COUNTY ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $283.00 | 1528134293 - MARYLAND AESTHETIC AND RECONSTRUCTIVE AMBULATORY SURGICAL CENTER LLC | 522277480 - (MD) MARYLAND AESTHETIC AND RECONSTRUCTIVE AMBULATORY SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $1678.00 | 1881692036 - SAINT BARNABAS OUTPATIENT CENTERS, AMBULATORY SURGERY CENTER | 222458479 - (NJ) SAINT BARNABAS OUTPATIENT CENTERS | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $462.00 | 1427078930 - RETINA CONSULTANTS SURGERY CENTER | 223314785 - (NJ) RETINA CONSULTANTS SURGERY CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $1504.00 | 1124771985 - WAKEMED SURGERY CENTER | 874584595 - (NC) WAKEMED SURGERY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43253 | $643.00 | 1689149601 - ATLANTA PREMIER FOOT AND ANKLE SURGERY | 825318197 - (GA) ATLANTA PREMIER FOOT AND ANKLE SURGERY | GA | 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 43253 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43253 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 43253 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 |
|---|---|---|
| 43253-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Transendoscopic Ultrasound-Guided Transmural Injection Of Diagnostic Or Therapeutic Substance(S) (Eg Anesthetic Neurolytic Agent) Orfiducial Marker(S) (Includes Endoscopic Ultrasoundexamination Of The Esophagus Stomach And Either The Duodenum Or A Surgically Altered Stomach Wherethe Jejunum Is Examined Distal To The Anastomosis) |
| 43259-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Endoscopic Ultrasound Examination Including The Esophagus Stomach And Either The Duodenum Ora Surgically Altered Stomach Where The Jejunum Is Examined Distal To The Anastomosis (Revised 01/01/2014) |
| 43276-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Removal And Exchange Of Stent(S) Biliary Or Pancreatic Duct Including Pre- And Post-Dilation And Guide Wire Passage When Performed Including Sphincterotomy When Performed Each Stent Exchanged. |
| 43280-CPT | High | Laparoscopy, Surgical; Esophogogastric Fundoplasty |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43253. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43253 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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