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See a sample rate comparisonCPT 43291 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.
Remove Balloon From Stomach, Examination Of The Esophagus Stomach And Intestines Using A Scope (Endoscope). The Procedure Removes A Balloon-Like Device Previously Implanted 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 21 - Inpatient Hospital |
| Common Modifiers | AG - Primary physician UB |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $506.69 national non-facility rate (2026) · View Medicare rates for 43291 |
| Medicaid Fee Schedule | $267.55 median of the 8 states in the free preview · View Medicaid rates for 43291 |
National average reimbursement for CPT 43291 by major payers:
$589.36
$654.97
$615.52
$291.66
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CPT 43291
5 of 25 sample ratesHigher to lower in this preview
North Garland Surgery Center LLP, Baylor Scott & White Surgicare - North Garland
North Garland Surgery Center LLP
$2,172.00Published ratePacific Endoscopy Center, LLC
$1,276.00Published ratePhysicians Surgery Center Of Tempe, LLC, Physicians Surgery Center Of Tempe
Physicians Surgery Center Of Tempe LLC
$1,233.00Published rateEndoscopy Center Of St Thomas LLC, Ngs Endoscopy Center
Endoscopy Center Of St Thomas LLC
$592.00Published rateLake Surgery & Endoscopy Center Ltd
Lake Surgery Endoscopy Center Ltd
$390.00Published rate
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See a sample payer proposalCPT 43291 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43291 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 43291 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 |
|---|---|---|
| 43284-CPT | Moderate | Laps Esophgl Sphnctr Agmntj, Laparoscopy Surgical Esophageal Sphincter Augmentation Procedure Placement Of Sphincter Augmentation Device Ie Magnetic Band Including Cruroplasty When Performed |
| 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. |
| 43291-CPT | Moderate | Remove Balloon From Stomach, Examination Of The Esophagus Stomach And Intestines Using A Scope (Endoscope). The Procedure Removes A Balloon-Like Device Previously Implanted In The Stomach To Help With Weight Loss. |
| 43300-CPT | Moderate | Esophagoplasty (Plastic Repai, Esophagoplasty (Plastic Repair Or Reconstruction) Cervicalapproach Without Repair Of Tracheoesophageal Fistula |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43291. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43291 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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