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See a sample rate comparisonCPT 0043U 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.
Test For Tick-Borne Illness, Tick-Borne Relapsing Fever Is Caused By Various Borrelia Species And This Test Detects Antibodies Produced In Response. A Follow-Up Test Confirms A Positive Result.
| Key Fact | Detail |
|---|---|
| Service Type | Proprietary Laboratory Analyses |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 0043U |
| Medicaid Fee Schedule | View Medicaid rates for 0043U |
National average reimbursement for CPT 0043U by major payers:
$12.25
$14.87
$28.85
$21.53
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CPT 0043U
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$32.69Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$17.65Published rateKelly Ridges
Allergy & Asthma Of Dupage, S.C.
$11.89Published rateMichael Shuler
Athens Orthopedic Clinic, P.A.
$8.92Published rateMolly Mcintosh
Baycare Medical Group Inc
$6.23Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 0043U vs. Other Proprietary Laboratory Analyses Codes
The CPT 0043U code is part of the Proprietary Laboratory Analyses services . 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 0043U 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 |
|---|---|---|
| 0043U-CPT | Low | Test For Tick-Borne Illness, Tick-Borne Relapsing Fever Is Caused By Various Borrelia Species And This Test Detects Antibodies Produced In Response. A Follow-Up Test Confirms A Positive Result. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 0043U. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 0043U 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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