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See a sample rate comparisonCPT 43020 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.
Esophagotomy Cervical Approac, Esophagotomy Cervical Approach With Removal Of Foreignbody Esophagotomy Cervical Approach With Removal Of Foreign
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | 62 - Co-Surgeons AG - Primary physician 78 - Return to OR - related procedure 58 - Staged or related procedure during postoperative period |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $551.78 national non-facility rate (2026) · View Medicare rates for 43020 |
| Medicaid Fee Schedule | $434.27 median of the 8 states in the free preview · View Medicaid rates for 43020 |
National average reimbursement for CPT 43020 by major payers:
$697.60
$744.86
$771.37
$907.05
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CPT 43020
5 of 25 sample ratesHigher to lower in this preview
Marin Health Ventures, LLC, Marin Specialty Surgery Center
Marin Health Ventures, Inc. Dba Marin Specialty Surgery Center
$2,574.00Published ratePrescott Outpatient Surgical Center LLC
Prescott Outpatient Surgical Center, Lp
$1,258.00Published rateNational Surgical Centers Stockton, LLC
National Surgical Centers Stockt
$775.00Published rateSan Luis Walk-In Clinic, Inc., San Luis Outpatient Surgery Center
San Luis Walk-In Clinic Inc
$600.00Published rateBaltimore Endoscopy Asc LLC, Gastrointestinal Diagnostic Center
Baltimore Endoscopy Asc LLC
$398.00Published rate
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See a sample payer proposalCPT 43020 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43020 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 43020 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 |
|---|---|---|
| 43020-CPT | Moderate | Esophagotomy Cervical Approac, Esophagotomy Cervical Approach With Removal Of Foreignbody Esophagotomy Cervical Approach With Removal Of Foreign |
| 43045-CPT | High | Esophagotomy Thoracic Approac, Esophagotomy Thoracic Approach With Removal Of Foreignbody Esophagotomy Thoracic Approach With Removal Of Foreign |
| 43100-CPT | Moderate | Xcision Of Lesion Esophag W/ Primar Rpair; Cervcal Approa, Excision Of Lesion Esophagus With Primary Repair; Cervical Approach |
| 43101-CPT | High | Xcision Of Lesion Esophag W/ Primar Rpair; Thoracic Or Abdomi, Excision Of Lesion Esophagus With Primary Repair; Thoracic Or Abdomi |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43020. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43020 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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