CPT 43263 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 | Endoscopic Retrograde Cholangiopancreatography (ERCP) Procedures Endoscopy Procedures on the Esophagus |
| 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 43263 |
National average reimbursement for CPT 43263 by major payers:
$499.75
$511.00
$517.30
$603.18
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 43263 | $830.00 | 1962670687 - INLAND SURGERY CENTER INC | 208078312 - (CA) INLAND SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $1320.00 | 1023005600 - PSHS BETA PARTNERS LTD, THE GABLES SURGICAL CENTER | 650848650 - (FL) PSHS BETA PARTNERS LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $911.00 | 1639476377 - LIVONIA OUTPATIENT SURGERY CENTER, LLC | 261322609 - (MI) LIVONIA OUTPATIENT SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $2353.00 | 1104298009 - RED CEDAR SURGERY CENTER, LLC, RED CEDAR SURGERY CENTER, PLLC | 472947364 - (MI) RED CEDAR SURGERY CENTER, PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $2206.00 | 1891257473 - WESTGATE SURGERY CENTER, LLC, WESTGATE SURGERY CENTER | 352651945 - (AZ) WESTGATE SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $1713.00 | 1265009005 - SURGCENTER NORTHERN PHOENIX LLC | 854160690 - (AZ) SURGCENTER NORTHERN PHOENIX LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $1283.00 | 1215185335 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $622.00 | 1104899855 - SOUTHFIELD ENDOSCOPY ASC LLC, GASTROINTESTINAL ENDOSCOPY CENTER | 943421929 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $541.00 | 1386602332 - THREE RIVERS ENDOSCOPY CENTER, INC. | 251788887 - (PA) THREE RIVERS ENDOSCOPY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $4617.00 | 1821332370 - RIVER VALLEY ASC LLC, RIVER VALLEY ASC, LLC | 460758315 - (CT) RIVER VALLEY ASC LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $870.00 | 1982637492 - TOMOKA SURGERY CENTER, LLC | 201218596 - (FL) TOMOKA SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $830.00 | 1578679726 - SURGEYECARE, INC., SURGEYECARE GENERAL PARTNERSHIP | 752184300 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $4263.00 | 1487012480 - LAKE SPIVEY AMBULATORY SURGERY CARE, LLC, SPIVEY STATION SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $1300.00 | 1760860977 - MID MISSOURI SURGERY CENTER, LLC, SURGERY CENTER AT THE FORUM | 464006663 - (MO) MID-MISSOURI SURGERY CENTER, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43263 | $1145.00 | 1861089666 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC ASC TUCSON 5TH ST | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | 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 |
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CPT 43263 vs. Other Endoscopy Procedures on the Esophagus Codes
The CPT 43263 code is part of the Endoscopic Retrograde Cholangiopancreatography (ERCP) Procedures services used for Endoscopy Procedures on the Esophagus. 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 43263 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 | Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Removes A Sample Of Tissue For Testing. |
| 43262-CPT | Moderate | Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Includes Cutting Of A Sphincter (Band Of Muscle Around An Opening) To Free The Flow Of Bile Blocked By A Gallstone Or Other Material. |
| 43263-CPT | Moderate | Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Includes Pressure Measurement Of A Sphincter (Band Of Muscle Around An Opening). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43263. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43263 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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