Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 43270 Fee Schedule
Last Verified: October 2026
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.
Esophagogastroduodenoscopy Fl, 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)
| 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 | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $802.62 national non-facility rate (2026) · View Medicare rates for 43270 |
| Medicaid Fee Schedule | $629.25 median of the 8 states in the free preview · View Medicaid rates for 43270 |
National average reimbursement for CPT 43270 by major payers:
$842.62
$966.53
$1,051.33
$423.45
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43270.
CPT 43270
5 of 25 sample ratesHigher to lower in this preview
Hinsdale Surgical Center, LLC
Adventist Midwest Health
$2,954.00Published rateWasatch Front Surgery Center LLC
$1,446.00Published rateIredell Physician Network LLC, Iredell Ambulatory Surgery Center
$780.00Published rateSki Ambulatory Surgical Centers, LLC
Ski Ambulatory Surgical Centers LLC
$620.00Published rateMetrolina Vascular Access Care LLC
$475.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 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 | Upper Gastrointestinal Endosco, Upper Gastrointestinal Endoscopy Including Esophagusstomach And Either The Duodenum Andor Jejunumas Appropriate With Insertion Of Guide Wire Fol Lowed By |
| 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 |
| 43251-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 |
| 43270-CPT | Moderate | Esophagogastroduodenoscopy Fl, 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43270) and we'll show you how you compare in 15 minutes or less.