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See a sample rate comparisonCPT 43253 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.
Egd Us Transmural Injxn Mark, Esophagogastroduodenoscopy Flexible Transoral With Transendoscopic Ultrasound Guided Transmural Injection Of Diagnostic Or Therapeutic Substance S Eg Anesthetic Neurolytic Agent Or Fiducial Marker S Includes Endoscopic Ultrasound Examination Of The Esophagus Stomach And Either The Duodenum Or A Surgically Altered Stomach Where The Jejunum Is Examined Distal To The Anastomosis
| 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 | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $230.13 national non-facility rate (2026) · View Medicare rates for 43253 |
| Medicaid Fee Schedule | $186.025 median of the 8 states in the free preview · View Medicaid rates for 43253 |
National average reimbursement for CPT 43253 by major payers:
$354.63
$369.10
$388.30
$448.05
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CPT 43253
5 of 25 sample ratesHigher to lower in this preview
Ambulatory Surgical Pavilion At Robert Wood Johnson LLC
$1,892.00Published rateMdsine, LLC, Spine Institute Of New England
Mdsine LLC
$1,267.00Published ratePg County Endoscopy Center LLC
$715.00Published rateHermitage Tn Endoscopy Asc, LLC, Associated Endoscopy
$491.00Published rateMaryland Aesthetic And Reconstructive Ambulatory Surgical Center LLC
$283.00Published rate
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See a sample payer proposalCPT 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 | Egd Us Transmural Injxn Mark, Esophagogastroduodenoscopy Flexible Transoral With Transendoscopic Ultrasound Guided Transmural Injection Of Diagnostic Or Therapeutic Substance S Eg Anesthetic Neurolytic Agent Or Fiducial Marker S Includes Endoscopic Ultrasound Examination Of The Esophagus Stomach And Either The Duodenum Or A Surgically Altered Stomach Where The Jejunum Is Examined Distal To The Anastomosis |
| 43259-CPT | Moderate | Egd Us Exam Duodenum Jejunum, Esophagogastroduodenoscopy Flexible Transoral With Endoscopic Ultrasound Examination Including The Esophagus Stomach And Either The Duodenum Or A Surgically Altered Stomach Where The Jejunum Is Examined Distal To The Anastomosis |
| 43276-CPT | Moderate | Ercp Stent Exchange W Dilate, 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 | Esophagus Surgery For Reflux, Surgery To Repair A Weakened Valve Or Muscle Between The Esophagus And The Stomach. The Procedure Relieves Acid Reflux. |
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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