CPT 43270 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 |
| Medicare Fee Schedule | View Medicare rates for 43270 |
National average reimbursement for CPT 43270 by major payers:
$842.62
$966.53
$1,051.33
$1,187.86
| 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 43270 | ||||||
United | 43270 | $780.00 | 1578073631 - IREDELL PHYSICIAN NETWORK LLC, IREDELL AMBULATORY SURGERY CENTER | 263853529 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $1509.00 | 1780964866 - BAPTIST PLAZA SURGICARE, LP, NASHVILLE ENDOSURGERY CENTER | 800033564 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $1725.00 | 1710060751 - BAY AREA SURGICAL GROUP, INC. | 201198494 - (CA) BAY AREA SURGICAL GROUP, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $651.00 | 1184844607 - SPECIALTY CARE AND SURGERY CENTER | 954176904 - (CA) PAULA R. DHANDA, MD | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $611.00 | 1720752629 - BAY SURGERY CENTERS | 453365193 - (MD) BAY SURGERY CENTERS | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $2954.00 | 1841234150 - HINSDALE SURGICAL CENTER, LLC | 362276984 - ADVENTIST MIDWEST HEALTH | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $487.00 | 1306958103 - NEI AMBULATORY SURGERY CENTER INC PC | 232429169 - (PA) NEI AMBULATORY SURGERY CENTER INC PC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $517.00 | 1821279720 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND THERAPEUTIC CENTER | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $500.00 | 1467783688 - PREMIER SURGICAL CENTER LLC | 261807944 - (FL) PREMIER SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $620.00 | 1174067318 - SKI AMBULATORY SURGICAL CENTERS, LLC | 813831008 - (AZ) SKI AMBULATORY SURGICAL CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $1123.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $2382.00 | 1861913220 - SJV MANAGEMENT, LLC, SOUTH JERSEY VASCULAR SURGERY CENTER | 202273476 - (NJ) SJV MANAGEMENT, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $1258.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $669.00 | 1740287168 - AFFILIATED PHYSICIANS & SURGEONS, LTD | 860495569 - (AZ) AFFILIATED PHYSICIANS SURGEONS LTD | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43270 | $1179.00 | 1134126097 - PHYSICIAN'S SURGERY CENTER OF KNOXVILLE LLC | 621777892 - (TN) PHYSICIANS SURGERY CENTER OF KNOXVILLE LLC | TN | 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 43270 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43270 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 43270 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 | Esophagogastroduodenoscopy Flexible Transoral; With Insertion Of Guide Wire Followed By Passage Of Dilator(S) Through Esophagus Over Guide Wire (Revised 01/01/2014) |
| 43250-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Removal Of Tumor(S) Polyp(S) Or Other Lesion(S) By Hot Biopsy Forceps (Revised 01/01/2015) |
| 43251-CPT | Moderate | Esophagogastroduodenoscopy Flexible Transoral; With Removal Of Tumor(S) Polyp(S) Or Other Lesion(S) By Snare Technique (Revised 01/01/2014) |
| 43270-CPT | Moderate | Esophagogastroduodenoscopy, Flexible, Transoral; With Ablation Of Tumor(S), Polyp(S), Or Other Lesion(S) (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 43270. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43270 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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