CPT 43262 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $340.29 Physician Fee Schedule |
National average reimbursement for CPT 43262 by major payers:
$510.82
$515.07
$549.93
$621.44
| 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 43262 | ||||||
United | 43262 | $1645.00 | 1487158796 - CENTRIC AMBULATORY SURGERY CENTER LLC | 824465250 - (MO) CENTRIC AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $1623.00 | 1629713730 - PG COUNTY ENDOSCOPY CENTER LLC | 881766792 - (MD) PG COUNTY ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $986.00 | 1881736734 - MILLENIA SURGERY CENTER LLC | 562384725 - (FL) MILLENIA SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $774.00 | 1164414447 - EAST VALLEY ENDOSCOPY LLC | 870667809 - (AZ) EAST VALLEY ENDOSCOPY, PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $830.00 | 1366449910 - OREGON ENDOSCOPY CENTER, LLC | 931311609 - (OR) OREGON ENDOSCOPY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $1240.00 | 1811057029 - GREENSBORO NC ENDOSCOPY ASC LLC, GUILFORD ENDOSCOPY CENTER | 203802443 - (NC) GREENSBORO NC ENDOSCOPY ASC LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $1574.00 | 1881738607 - NACOGDOCHES COUNTY HOSPITAL DISTRICT, NACOGDOCHES MEMORIAL HOSPITAL DAY SURG CIDC | 871142127 - (TX) LION STAR NACOGDOCHES HOSPITAL, LLC DBA NACOGDOCHES MEMORIAL HOSPITAL | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $6245.00 | 1295887727 - TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | 751047527 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $2119.00 | 1336790237 - AURORA ENDOSCOPY SURGICENTER, LLC | 825396997 - (CO) AURORA ENDOSCOPY SURGICENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $830.00 | 1639694797 - UCSD CENTER FOR SURGERY OF ENCINITAS, L.P. | 822326631 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $1685.00 | 1285889378 - PARADIGM CLINICAL ASSOCIATES LLC, STRATHAM AMBULATORY SURGERY CENTER | 262382365 - (NH) PARADIGM CLINICAL ASSOCIATES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $2408.00 | 1356965750 - PROLIANCE SURGERY CENTER AT VALLEY, LLC | 842108616 - (WA) PROLIANCE SURGERY CENTER AT VALLEY LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $825.00 | 1538242649 - SOUTHWESTERN ENDOSCOPY CENTER, LLC | 571139709 - (PA) SOUTHWESTERN ENDOSCOPY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $830.00 | 1407932619 - PACIFIC EYE INSTITUTE A MEDICAL GROUP INC, PACIFIC EYE INSTITUTE AMBULATORY SURGERY CTR | 330303507 - (CA) PACIFIC EYE INSTITUTE MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $606.00 | 1770557233 - MESA AZ ENDOSCOPY ASC LLC, DESERT ENDOSCOPY CENTER | 510426858 - (AZ) THE MESA AZ ENDOSCOPY ASC, LLC | AZ | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 43262 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43262 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 43262 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 |
|---|---|---|
| 43260-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed(Separate Procedure) (Revised 01/01/2014) |
| 43261-CPT | Moderate | Ercp; With Biopsy, Single Or Multiple |
| 43262-CPT | Moderate | Ercp,W/Wo Bx/Coll.Specimen;Sphincterotom |
| 43263-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Pressure Measurement Of Sphincter Of Oddi (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43262. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43262 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43262) and we'll show you how you compare in 15 minutes or less.