CPT 43265 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $411.77 Physician Fee Schedule |
National average reimbursement for CPT 43265 by major payers:
$621.73
$646.90
$678.48
$768.04
| 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 43265 | ||||||
United | 43265 | $1194.00 | 1730843830 - VOLUSIA ASC BZ, LLC, ADVANCED HEART AND VASCULAR SURGERY CENTER AT DELTONA | 851554243 - (FL) VOLUSIA ASC BZ, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $544.00 | 1225245723 - FRESNO ENDOSCOPY CENTER | 770462622 - (CA) FRESNO ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $1540.00 | 1518423672 - PACIFIC RITZ SURGERY CENTER, LLC | 823738789 - (CA) PACIFIC RITZ SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $875.00 | 1952323081 - DOCTORS OUTPATIENT SURGERY CENTER, LLC | 412097984 - (FL) DOCTORS OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $950.00 | 1124777321 - VIRGINIA CARDIOVASCULAR SPECIALISTS, VCS HEART AND VASCULAR CENTER | 541090122 - (VA) VIRGINIA CARDIOVASCULAR SPECIALISTS PC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $1100.00 | 1881704237 - WATERFRONT SURGERY CENTER LLC | 251898743 - (PA) WATERFRONT SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $1530.00 | 1609965961 - BROOKINGS AMBULATORY SURGERY CENTER, LLP | 203272258 - (SD) BROOKINGS AMBULATORY SURGERY CENTER LLP | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $700.00 | 1083898605 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC, MIDSOUTH PAIN TREATMENT CENTER, LLC | 261545635 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $830.00 | 1437274495 - EYE SURGICAL CENTER OF SAN FRANCISCO LLC, EYE SURGERY CENTER OF SAN FRANCISCO | 203822864 - (CA) EYE SURGERY CENTER OF SAN FRANCISCO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $784.35 | 1942705694 - KHALIL BEYDOUN | 350593390 - DEACONESS HOSPITAL INC | MI | Anesthesiology Physician (207L00000X) |
United | 43265 | $360.38 | 1134462070 - JENNIFER SITZMAN | 350593390 - DEACONESS HOSPITAL INC | IN | Family Nurse Practitioner (363LF0000X) |
United | 43265 | $2859.00 | 1821342858 - SURGCENTER OF ORANGE PARK, LLC, ORANGE PARK ENDOSCOPY CENTER | 460858710 - (FL) SURGCENTER OF ORANGE PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $1600.00 | 1043660442 - GEORGIA INTERVENTIONAL PAIN | 812790376 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $920.00 | 1750612446 - BAY SURGERY CENTERS, CLEARWAY SURGERY CENTER OF GLEN BURNIE | 271271303 - (MD) BAY SURGERY CENTERS | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43265 | $3150.00 | 1437552643 - BEAR CREEK SURGERY CENTER, LLC | 465530768 - (TX) BEAR CREEK SURGERY CENTER, LLC | TX | 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 43265 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43265 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 43265 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) |
| 43264-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Removal Of Calculi/Debris From Biliary/Pancreatic Duct(S) (Revised 01/01/2014) |
| 43265-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Destruction Of Calculi Any Method (Eg Mechanical Electrohydraulic Lithotripsy) (Revised 01/01/2014) |
| 43266-CPT | Moderate | Once Per Dos Esophagogastroduodenoscopy, Flexible, Transoral; W/Placement Of Endoscopic Stent (Includes Pre- & Post-Dilation & Guide Wire Passage, When Performed) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43265 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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