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See a sample rate comparisonCPT 43113 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.
Removal Of Esophagus, Total Or Near Total Esophagectomy With Thoracotomy With Colon Interposition Or Small Intestine Reconstruction Including Intestine Mobilization Preparation And Anastomosis Es
| 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 | 62 - Co-Surgeons 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | $4,031.16 national non-facility rate (2026) · View Medicare rates for 43113 |
| Medicaid Fee Schedule | $3,116.90 median of the 8 states in the free preview · View Medicaid rates for 43113 |
National average reimbursement for CPT 43113 by major payers:
$5,129.76
$5,639.39
$5,922.17
$6,685.93
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CPT 43113
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Endoscopy Center North Freeway LLC, Memorial Hermann Endoscopy Center North Loop
$4,893.00Published rateMedstar Surgery Center At Timonium, LLC
Medstar Surgery Center At Timo
$1,348.00Published rateCcrm Florida LLC, Ccrm Florida
Ccrm Florida LLC
$894.00Published rateAmbulatory Surgical Center Of Southern Nevada LLC
$531.00Published rateSouthwest Endoscopy And Surgery Center
$220.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 43113 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43113 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 43113 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 |
|---|---|---|
| 43108-CPT | High | Removal Of Esophagus, Total Or Near Total Esophagectomy Without Thoracotomy With Colon Interposition Or Small Intestine Reconstruction Including Intestine Mobilization Preparation And Anastomosis Es |
| 43112-CPT | High | Total Or Near Total Esophagectomy With Thoracotomy; With Pharyngogastrostomy Or Cervical Esophagogastrostomy With Or Without Pyloroplasty (Ie Mckeown Esophagectomy Or Tri-Incisional Esophagectomy) (Desc Revised 1/1/2018) |
| 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 |
| 43117-CPT | High | Partial Removal Of Esophagus, Partial Esophagectomy Distal Two Thirds With Thoracotomy And Separate Abdominal Incision With Or Without Proximal Gastrectomy With Thoracic Esophagogastrostomy With Or Without Pyloroplasty Ivor Lewis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43113. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43113 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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