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 43116 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.
Surgery To Remove Esophagus, Surgery To Remove All Or Most Of The Esophagus. The Surgery May Include Reconstructing A Passage To The Stomach Or Intestines. Reconstruction May Involve A Graft.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital |
| Common Modifiers | 52 - Reduced Services AS - PA/NP/CNS assistant at surgery 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | $4,578.26 national non-facility rate (2026) · View Medicare rates for 43116 |
| Medicaid Fee Schedule | $3,536.455 median of the 8 states in the free preview · View Medicaid rates for 43116 |
National average reimbursement for CPT 43116 by major payers:
$6,112.25
$6,421.70
$6,778.99
$7,781.80
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43116.
CPT 43116
5 of 25 sample ratesHigher to lower in this preview
Kerlan-Jobe Surgery Center LLC, Healthsouth / Kerlan-Jobe Surgery Center LLC
Kerlanjobe Surgery Center LLC
$1,995.00Published rateMedstar Surgery Center At Lafayette Centre, LLC
Medstar Surgery Center At Lafayette Centre LLC
$1,234.00Published rateBarrington Surgical Care LLC, Barrington Surgical Care
Barrington Surgical Care LLC
$775.00Published rateDigestive Health Center LLC
Digestive Health Center, Ltd.
$430.00Published rateMesa Az Endoscopy Asc LLC, Desert Endoscopy Center
The Mesa Az Endoscopy Asc, LLC
$103.00Published 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 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 |
|---|---|---|
| 43107-CPT | High | Total Or Near Total Esophagect, Total Or Near Total Esophagectomy Without Thoracotomy Withpharyngogastrostomy Or Cervical Esophagogastrostomy With Or Without Pyloroplasty (Transhiatal) |
| 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 |
| 43116-CPT | High | Surgery To Remove Esophagus, Surgery To Remove All Or Most Of The Esophagus. The Surgery May Include Reconstructing A Passage To The Stomach Or Intestines. Reconstruction May Involve A Graft. |
| 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 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43116) and we'll show you how you compare in 15 minutes or less.