Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 43259 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 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
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $198.74 national non-facility rate (2026) · View Medicare rates for 43259 |
| Medicaid Fee Schedule | $161.905 median of the 8 states in the free preview · View Medicaid rates for 43259 |
National average reimbursement for CPT 43259 by major payers:
$329.81
$338.71
$360.61
$394.24
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43259.
CPT 43259
5 of 25 sample ratesHigher to lower in this preview
Chaska Plaza Surgery Center, LLC, Two Twelve Surgery Center
Chaska Plaza Surgery Center LLC
$1,747.00Published rateCypress Ambulatory Surgery Center, LLC, Wellness Avenue Surgery Center
$1,275.00Published rateLutherville Surgicenter, LLC
Lutherville Surgicenter LLC
$833.00Published rateSurgical Specialty Suites, Inc
Surgical Specialty Suites Inc
$480.00Published rateBama Heart Doc, P.C., Alabama Heart And Vascular Medicine
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$242.74Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 43259 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43259 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 43259 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 |
| 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43259. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43259 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43259) and we'll show you how you compare in 15 minutes or less.