CPT 43118 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 • 62 - Co-Surgeons • 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| CMS | $3,458.49 Physician Fee Schedule |
National average reimbursement for CPT 43118 by major payers:
$4,432.51
$4,729.79
$4,981.28
$5,727.32
| 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 43118 | ||||||
United | 43118 | $289.00 | 1558007773 - HS SURGERY, PLLC | 862203027 - (MS) HS SURGERY PLLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $4165.00 | 1982871935 - NORTHERN VIRGINIA SURGERY CENTER LLC | 203502477 - (VA) NORTHERN VIRGINIA SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $426.00 | 1962609560 - FRONT RANGE ENDOSCOPY CENTERS, LLC | 205008349 - (CO) FRONT RANGE ENDOSCOPY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $381.00 | 1710924881 - GEORGIA DERMASURGERY CENTERS, INC. | 582495671 - (GA) GEORGIA DERMASURGERY CENTERS INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $1146.00 | 1003332883 - DESERT VISTA SURGICAL CENTER LLC | 821195281 - (AZ) DESERT VISTA SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $2652.00 | 1730876210 - MEDICAL CITY SURGERY CENTER NORTH TEXAS, LLC | 923326615 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $1030.00 | 1598328932 - ENDO GROUP, LLC | 200248148 - (NY) ENDO GROUP LLC DBA GARDEN CITY SURGICENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $875.00 | 1871574145 - SURGERY CENTER AT REGENCY PARK, LLC | 311570817 - (OH) SURGERY CENTER AT REGENCY PARK, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $200.00 | 1336687326 - ARROWHEAD SURGERY CENTER LLC | 475111160 - (AZ) ARROWHEAD SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $2785.00 | 1629703236 - NORTH CYPRESS SURGICENTER, LLC, NORTH CYPRESS SURGERY CENTER | 851383722 - (TX) NORTH CYPRESS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $814.00 | 1437138500 - CONCORD EYE SURGERY LLC | 20522032 - (NH) CONCORD EYE SURGERY LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $658.00 | 1174850176 - SOUTHWEST OHIO PAIN MANAGEMENT LLC | 300571536 - (OH) SOUTHWEST OHIO PAIN MANAGEMENT | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $1146.00 | 1770008922 - BANNER PHOENIX SURGERY CENTER LLC | 901182683 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $802.00 | 1689669418 - DIAGNOSTIC ENDOSCOPY LLC | 223750394 - (CT) DIAGNOSTIC ENDOSCOPY LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43118 | $618.00 | 1316009194 - ADVOCATE SOUTHWEST AMBULATORY SURGERY CENTER LLC, TINLEY WOODS SURGERY CENTER | 364437931 - (IL) ADVOCATE SOUTHWEST AMBULATORY SURGE | IL | 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 43118 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43118 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 43118 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 |
|---|---|---|
| 43118-CPT | High | Partial Esophagectomy, Distal Two-Thirds, With Thoracotomy And Separate Abdominal Incision, With Or Without Proximal Gastrectomy; With Colon Interposition Or Small Intestine Reconstruction, Including Intestine Mobilization, Preparation, And Anastomosis(Es) |
| 43121-CPT | High | Partial Esophagectomy, Distal Two-Thirds, With Thoracotomy Only, With Or Without Proximal Gastrectomy, With Thoracic Esophagogastrostomy, With Or Without Pyloroplasty |
| 43122-CPT | High | Partial Esophagectomy, Thoracoabdominal Or Abdominal Approach, With Or Without Proximal Gastrectomy; With Esophago-Gastrostomy, With Or Without Pyloroplasty |
| 43123-CPT | High | Partial Esophagectomy, Thoracoabdominal Or Abdominal Approach, With Or Without Proximal Gastrectomy; 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 43118. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43118 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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