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 |
| Medicare Fee Schedule | View Medicare rates for 43113 |
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 | $531.00 | 1629166624 - AMBULATORY SURGICAL CENTER OF SOUTHERN NEVADA LLC | 861081788 - (NV) AMBULATORY SURGICAL CENTER OF SOUTHERN NEVADA LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $1075.00 | 1841284742 - KLEINERT KUTZ SURGERY CENTER, LLC | 352095662 - (IN) KLEINERT KUTZ SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $1010.00 | 1366681355 - SALINA SURGICAL ARTS CENTER, LLC, DAVID A. HENDRICK M.D., P.A. | 208824691 - (KS) DAVID A. HENDRICK MD | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $632.00 | 1659903292 - RACINE DIGESTIVE HEALTH CENTER LLC | 844211105 - (WI) RACINE DIGESTIVE HEALTH CENTER LLC | WI | 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 | $220.00 | 1649494170 - SOUTHWEST ENDOSCOPY AND SURGERY CENTER | 203136303 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $1416.00 | 1417286428 - ALLIANCE SURGICAL CENTER LLC | 271367127 - (FL) ALLIANCE SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $1028.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $565.00 | 1295256295 - SOUTHWEST ATLANTA VASCULAR CARE, LLC | 820825564 - (GA) SOUTHWEST ATLANTA VASCULAR CARE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $894.00 | 1306589809 - CCRM FLORIDA LLC, CCRM FLORIDA | 873211160 - (FL) CCRM FLORIDA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $398.00 | 1033426580 - ADVANCED AMBULATORY SURGERY CENTER, LLC | 271607092 - (IN) ADVANCED AMBULATORY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $1028.00 | 1396211264 - PALM BEACH SURGICAL SUITES LLC | 830558319 - (FL) PALM BEACH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $352.00 | 1699813774 - LAUREL LASER & SURGERY CENTER, L.P., LAUREL LASER & SURGERY CENTER-ALTOONA | 251852464 - (PA) LAUREL LASER SURGERY CENTER LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $550.00 | 1184680407 - OAK BROOK SURGICAL CENTRE INC. | 363317971 - (IL) OAKBROOK SURGICAL CENTRE, INC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43113 | $2919.00 | 1619974219 - ST. JOSEPH'S SURGERY CENTER LP | 201019390 - (CA) ST JOSEPHS SURGERY CENTER LP | CA | 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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