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 |
| Medicare Fee Schedule | View Medicare rates for 43262 |
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 | $1474.00 | 1407824436 - ORAL FACIAL SURGERY CENTER, LLC, SPECIALTY SURGERY CENTER | 621488965 - (TN) ORAL FACIAL SURGERY CENTER, INC. | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $1954.00 | 1215900246 - SUNRISE OPHTHALMOLOGY ASC LLC, FOUNDATION FOR ADVANCED EYE CARE | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $956.00 | 1477698454 - REGIONAL EYE SURGERY CENTER,LLC | 721484653 - (LA) REGIONAL EYE SURGERY CENTER, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $2560.00 | 1902228455 - PROVIDENCE HEALTH & SERVICES WASHINGTON, PROVIDENCE SURGERY AND PROCEDURE CENTER | 881232814 - (WA) PROVIDENCE SURGERY AND PROCEDURE CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $7441.00 | 1104996768 - GREATER DAYTON SURGERY CENTER LLC | 202913367 - (OH) GREATER DAYTON SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $1750.00 | 1457976383 - VHC-I | 851094630 - (AZ) VHCI | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $1250.00 | 1659731669 - PHOENIX ASC, LP, CARDIAC SURGERY CENTER OF PHOENIX | 474334606 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $1499.00 | 1760457204 - ORTHOPAEDIC SURGERY CENTER OF ILLINOIS, LLC | 371366377 - (IL) ORTHOPAEDIC SURGERY CENTER OF ILLINOIS LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $614.00 | 1295131001 - OPTUMCARE COLORADO ASC, LLC, COLORADO SPRINGS HEALTH PARTNERS ASC, LLC | 352597463 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $1258.00 | 1053031237 - FRESENIUS VASCULAR CARE EL PASO ASC LLC | 861628275 - (TX) FRESENIUS VASCULAR CARE EL PASO ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $2667.00 | 1255787867 - THE METROHEALTH SYSTEM, METROHEALTH SYSTEM PARMA AMBULATORY SURGERY CENTER | 346004382 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43262 | $2000.00 | 1851848253 - PINNACLE SURGERY CENTER OF AUSTIN | 813117589 - (TX) PINNACLE SURGERY CENTER OF AUSTIN LLC | TX | 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 | $2388.00 | 1366982845 - JACKSONVILLE ENDOSCOPY CENTERS LLC, JACKSONVILLE CENTER FOR ENDOSCOPY | 384016302 | FL | 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 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.
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