Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 43101 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.
Xcision Of Lesion Esophag W/ Primar Rpair; Thoracic Or Abdomi, Excision Of Lesion Esophagus With Primary Repair; Thoracic Or Abdomi
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | $968.63 national non-facility rate (2026) · View Medicare rates for 43101 |
| Medicaid Fee Schedule | $793.86 median of the 8 states in the free preview · View Medicaid rates for 43101 |
National average reimbursement for CPT 43101 by major payers:
$1,283.83
$1,370.62
$1,383.61
$1,623.14
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43101.
CPT 43101
5 of 25 sample ratesHigher to lower in this preview
Castle Hills Surgicare, LLC
Castle Hills Surgicare LLC
$6,068.00Published rateCaromont Health Services, Inc., Caromont Specialty Surgery
Caromont Health Services Inc
$973.00Published rateWilmington Asc LLC
$648.00Published rateOrange City Surgical LLC, Adventhealth Surgery Center Blue Springs
Orange City Surgical, LLC
$410.00Published rateSouthland Endoscopy Center, Southland Endoscopy Center
Southland Endoscopy Center
$284.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 43101 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43101 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 43101 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 |
|---|---|---|
| 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 |
| 43113-CPT | High | Removal Of Esophagus, Total Or Near Total Esophagectomy With Thoracotomy With Colon Interposition Or Small Intestine Reconstruction Including Intestine Mobilization Preparation And Anastomosis Es |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43101. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43101 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43101) and we'll show you how you compare in 15 minutes or less.