CPT 43266 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 | Esophagogastroduodenoscopy Procedures Endoscopy Procedures on the Esophagus |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43266 |
National average reimbursement for CPT 43266 by major payers:
$284.74
$310.55
$318.65
$376.50
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 43266 | $864.00 | 1427051796 - SOUTH BEND IN ENDOSCOPY ASC LLC, MICHIANA ENDOSCOPY CENTER | 352011366 - (IN) SOUTH BEND IN ENDOSCOPY ASC LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $1176.00 | 1265770572 - PHILADELPHIA SURGERY CENTER, INC. | 454790325 - (PA) PHILADELPHIA SURGERY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $2700.00 | 1538166053 - SOUTHERN OB GYN AMBULATORY SURGERY CENTER, INC | 300070376 - (GA) SOUTHERN OB GYN AMBULATORY SURGERY CENTER INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $965.00 | 1295851137 - PHYSICIANS SURGERY CENTER LLC | 200435814 - (AR) PHYSICIANS SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $825.00 | 1992018790 - REVISION ADVANCED SURGERY CENTER INC | 200734091 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $4339.00 | 1184635955 - SAN RAMON ENDOSCOPY CENTER INC | 680466508 - (CA) SAN RAMON ENDOSCOPY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $4600.00 | 1508871211 - TEXAS DIGESTIVE DISEASE CENTER, LTD | 273578014 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $432.00 | 1659516375 - BROOKLYN ENDOSCOPY SC, LLC, GNYESC | 205479673 - (NY) BROOKLYN ENDOSCOPY SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $672.00 | 1568466209 - BAYVIEW MEDICAL CENTER, INC, LMC AMBULATORY SURGERY CENTER | 541593723 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $2009.00 | 1134665193 - NHPE, LLC, NEW HYDE PARK ENDOSCOPY | 471158058 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $530.00 | 1134293814 - PLYMOUTH LASER CENTER, P.C., PLYMOUTH LASER & SURGICAL CENTER | 43292630 - (MA) PLYMOUTH LASER CENTER PC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $863.00 | 1538109384 - PLASTIC SURGERY SPECIALISTS, PC | 521357688 - (MD) PLASTIC SURGERY SPECIALISTS, P.C. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $2795.00 | 1942397104 - PREMIER ENDOSCOPY, LLC | 50599351 - (NJ) PREMIER ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $2010.00 | 1679804355 - LONESTAR AMBULATORY SURGICAL CENTER | 263806076 - (TX) LONESTAR AMBULATORY SURGICAL CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43266 | $1414.00 | 1346331329 - PHYSICIANS EYE SURGERY CENTER LLC, PHYSICIANS' EYE SURGERY CENTER | 571116347 - (SC) PHYSICIANS EYE SURGERY CENTER | SC | 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 43266 vs. Other Endoscopy Procedures on the Esophagus Codes
The CPT 43266 code is part of the Esophagogastroduodenoscopy 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 43266 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 |
| 43266-CPT | Moderate | Esophagogastroduodenoscopy Fl, Esophagogastroduodenoscopy Flexible Transoral With Placement Of Endoscopic Stent (Includes Pre- And Post-Dilation And 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 43266. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43266 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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