CPT 43116 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 |
| Common Modifiers | • None • 52 - Reduced Services • AS - PA/NP/CNS assistant at surgery • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43116 |
National average reimbursement for CPT 43116 by major payers:
$6,112.25
$6,421.70
$6,778.99
$7,781.80
| 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 43116 | ||||||
United | 43116 | $426.00 | 1760770903 - ASSOCIATED SURGICAL CENTER OF DEARBORN LLC | 275209399 - (MI) ASSOCIATED SURGICAL CENTER OF DEARBORN LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $585.00 | 1275184293 - JOHNS HOPKINS SURGERY CENTERS SERIES, BEL AIR SURGERY CENTER | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $103.00 | 1770557233 - MESA AZ ENDOSCOPY ASC LLC, DESERT ENDOSCOPY CENTER | 510426858 - (AZ) THE MESA AZ ENDOSCOPY ASC, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $463.00 | 1376159228 - COMPREHENSIVE SURGICAL CARE OF RENO-TAHOE, LLC | 851492944 - (NV) COMPREHENSIVE SURGICAL CARE OF RENOTAHOE LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $1836.00 | 1881129351 - OCONTO HOSPITAL & MEDICAL CENTER, INC., BELLIN HEALTH MARINETTE SURGERY CENTER | 61745397 - OCONTO HOSPITAL & MEDICAL CENTER INC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $430.00 | 1346386604 - DIGESTIVE HEALTH CENTER LLC | 341955920 - DIGESTIVE HEALTH CENTER, LTD. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $1234.00 | 1912090432 - MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE, LLC | 812557673 - (DC) MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE LLC | DC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $550.00 | 1689624793 - SURGERY CENTER OF SOUTHWEST FLORIDA INC | 843798404 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $802.00 | 1740823848 - KING OF PRUSSIA SURGERY CENTER, LLC, KING OF PRUSSIA SURGERY CENTER | 832782091 - (PA) KING OF PRUSSIA SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $1274.00 | 1205361052 - MINIMALLY INVASIVE SURGERY CENTER OF N.E., LLC | 815005653 | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $1955.00 | 1245798826 - SURGCENTER OF GREATER DALLAS, LLC., SURGCENTER OF GREATER DALLAS | 831498677 - (TX) SURGCENTER OF GREATER DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $775.00 | 1801994553 - BARRINGTON SURGICAL CARE LLC, BARRINGTON SURGICAL CARE | 203991455 - (NH) BARRINGTON SURGICAL CARE LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $150.00 | 1205998648 - REGIONAL EYE ASSOCIATES, INC, SURGICAL EYE CENTER OF MORGANTOWN | 550740986 - REGIONAL EYE ASSOCIATES, INC. | WV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $345.00 | 1922237213 - ENDOSCOPY CENTER OF TOMS RIVER, LLC | 300568338 - (NJ) ENDOSCOPY CENTER OF TOMS RIVER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43116 | $855.00 | 1225781891 - SURGERY NEVADA LLC | 874665425 | NV | 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 43116 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43116 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 43116 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 |
|---|---|---|
| 42953-CPT | High | Repair Pharyngoesophageal |
| 43107-CPT | High | Total Or Near Total Esophagectomy, Without Thoracotomy; With Pharyngogastrostomy Or Cervical Esophagogastrostomy, With Or Without Pyloroplasty (Transhiatal) (Revision 2011) |
| 43108-CPT | High | Total Or Near Total Esophagectomy, Without Thoracotomy; With Colon Interposition Or Small Intestine Reconstruction, Including Intestine Mobilization, Preparation And Anastomosis(Es) |
| 43116-CPT | High | Partial Esophagectomy, Cervical, With Free Intestinal Graft, Including Microvascular Anastomosis, Obtaining The Graft And Intestinal Reconstruction |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43116 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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