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See a sample rate comparisonCPT 43453 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.
Dilate Esophagus W Guide
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $831.68 national non-facility rate (2026) · View Medicare rates for 43453 |
| Medicaid Fee Schedule | $658.375 median of the 8 states in the free preview · View Medicaid rates for 43453 |
National average reimbursement for CPT 43453 by major payers:
$707.81
$911.03
$1,005.02
$195.44
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CPT 43453
5 of 25 sample ratesHigher to lower in this preview
Northshore Regional Medical Center Dba The Surgery Suite, The Surgery Suite
Ochsner Clinic Foundation
$9,152.00Published rateStrictly Pediatrics Surgery Center Of Central Texas, LLC, Strictly Pediatrics Surgery Center
Strictly Pediatrics Surgery Center Of Texas, LLC
$1,379.00Published rateHamilton Endoscopy And Surgery Center, LLC
Hamilton Endoscopy & Surgery Center, LLC
$842.00Published rateBrockton Endoscopy Surgery Center Lp
$580.00Published rateWomens Center For Advanced Surgery Inc
$453.00Published rate
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See a sample payer proposalCPT 43453 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43453 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 43453 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 |
|---|---|---|
| 43450-CPT | Moderate | Dilation Of Esophagus By Ung, Dilation Of Esophagus By Unguided Sound Or Bougie Single Or Multiple Passes Dilation Of Esophagus By Unguided Sound Or Bougie Single |
| 43453-CPT | Moderate | Dilate Esophagus W Guide |
| 43460-CPT | Moderate | Esophagogastric Tamponade W Balloon Seng |
| 43496-CPT | High | Intestine Tissue For Repair, Surgery That Uses Intestinal Tissue To Repair And Reconstruct Portions Of The Digestive System After Surgery For Cancer. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43453. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43453 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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