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See a sample rate comparisonCPT 43255 Fee Schedule
Medicare rates as of October 2026
CPT 43255 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 Control Of Bleeding Any Me Thod
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service XS - Separate Structure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $689.06 national non-facility rate (2026) · View Medicare rates for 43255 |
| Medicaid Fee Schedule | $540.275 median of the 8 states in the free preview · View Medicaid rates for 43255 |
National average reimbursement for CPT 43255 by major payers:
$608.78
BCBS / Anthem
$700.71
UnitedHealthcare
$777.38
Aetna
$386.63
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43255.
CPT 43255
5 of 25 sample ratesHigher to lower in this preview
Diego Colom Steele
Florida Hospital Physician Group Inc
$1,361.43Published rateWilliam Mayoral
Orlando Health Medical Group Inc
$1,033.18Published rateJoseph Cody
$749.05Published rateRahman Nakshabendi
Imad Al-Nakshabendi Md PA
$538.91Published rateMaria Valdes
CEDARS GASTROENTEROLOGISTS LLC (<10 NPIs)
$184.25Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 43255 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43255. Select one to see its fee schedule.
| 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 |
| 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 |
| 43255-CPT | Moderate | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Control Of Bleeding Any Me Thod |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43255. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43255 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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