CPT 43113 Fee Schedule
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.
| 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 • None • 22 - Increased Procedural Services |
| Complexity Level | High |
| CMS | $4,148.44 Physician Fee Schedule |
National average reimbursement for CPT 43113 by major payers:
$5,129.76
$5,639.39
$5,922.17
$6,834.78
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 43113 | ||||||
United | 43113 | $670.00 | 1518272087 - SIPI AMBULATORY SURGERY CENTER | 300638923 - (ID) SIPI AMBULATORY SURGERY CENTER | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $220.00 | 1649494170 - SOUTHWEST ENDOSCOPY AND SURGERY CENTER | 203136303 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $280.00 | 1275836645 - BROOKSTONE AMBULATORY SURGERY CENTER | 263097292 - (GA) BROOKSTONE AMBULATORY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $449.00 | 1306476197 - EAMC-LANIER AMBULATORY SURGERY CENTER, LLC | 843468862 - (AL) EAMCLANIER AMBULATORY SURGERY CENTER LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $475.00 | 1699286922 - HUMBLE VASCULAR SURGICAL CENTER LLC | 820905971 - (TX) HUMBLE VASCULAR SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $507.00 | 1053058255 - INDIANA VASCULAR SURGERY CENTER LLC | 871608290 - (IN) INDIANA VASCULAR SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $1049.00 | 1790252864 - TREASURE COAST ASC, LLC, TREASURE COAST CENTER FOR SURGERY | 384092821 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $973.00 | 1083659866 - ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP, FOUNDATION SURGERY AFFILIATE OF SAN ANTONIO LP | 742976746 - (TX) ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $4165.00 | 1659793891 - INOVA AMBULATORY SURGERY CENTER AT LORTON, LLC | 461955980 - (VA) INOVA AMBULATORY SURGERY CENTER AT LORTON LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $557.00 | 1245233410 - SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC | 233022566 - (PA) SURGICAL SPECIALTY CENTER OF N | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $624.00 | 1215178835 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $6068.00 | 1407592769 - TEXAS HEALTH SURGERY CENTER WILLOW PARK LLC, TEXAS HEALTH ORTHOPEDIC AND SPINE SURGERY CENTER | 841953918 - (TX) TEXAS HEALTH SURGERY CENTER WILLOW PARK LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $2100.00 | 1164811923 - SHRINERS HOSPITALS FOR CHILDREN, SHRINERS HOSPITALS FOR CHILDREN AMBULATORY SURGERY CENTER-LEXINGTON | 362193608 - SHRINERS HOSPITALS FOR CHILDREN | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $66.00 | 1598879512 - NORTHLAND EYE SURGERY CENTER, LLC | 203685944 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $13865.00 | 1861444838 - LAS CRUCES SURGERY CENTER LP, MOUNTAINVIEW SURGERY CENTER | 421584742 | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 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 |
|---|---|---|
| 43045-CPT | High | Esophagotomy Thoracic W Rem Fb |
| 43108-CPT | High | 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 | 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 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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