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See a sample rate comparisonCPT 43290 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Implant Balloon In Stomach, Examination Of The Esophagus Stomach And Intestines Using A Scope (Endoscope). The Procedure Implants A Balloon-Like Device In The Stomach To Help With Weight Loss.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | $2,668.73 national non-facility rate (2026) · View Medicare rates for 43290 |
| Medicaid Fee Schedule | $1,477.495 median of the 8 states in the free preview · View Medicaid rates for 43290 |
National average reimbursement for CPT 43290 by major payers:
$3,220.43
$3,798.42
$3,519.00
$470.74
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CPT 43290
5 of 25 sample ratesHigher to lower in this preview
Riverwalk Surgery Center, Inc
$5,532.00Published rateUrlogy Ambulatory Surgery Center LLC, Wolf River Surgery Center
Urlogy Ambulatory Surgery Center LLC
$1,100.00Published rateEast Memphis Urology Center, Lp, Urocenter
East Memphis Urology Center Lp
$700.00Published rateRochester Endoscopy & Surgery Center, L.L.C.
Rochester Endoscopy Surgery Center LLC
$558.00Published rateLaurel Ambulatory Surgical Center
$228.00Published rate
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See a sample payer proposalCPT 43290 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43290 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 43290 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 |
| 43290-CPT | High | Implant Balloon In Stomach, Examination Of The Esophagus Stomach And Intestines Using A Scope (Endoscope). The Procedure Implants A Balloon-Like Device In The Stomach To Help With Weight Loss. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43290. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43290 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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