CPT 43121 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 • 78 - Return to OR - related procedure • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| CMS | $2,736.51 Physician Fee Schedule |
National average reimbursement for CPT 43121 by major payers:
$3,583.60
$3,735.18
$3,886.73
$4,532.54
| 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 43121 | ||||||
United | 43121 | $600.00 | 1295385482 - JOHNS HOPKINS SURGERY CENTERS SERIES | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $3418.00 | 1861538613 - CENTRACARE SURGERY CENTER, LLC | 611514974 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $983.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $775.00 | 1568060655 - WESTERN PA SURGERY CENTER, BEAVER COUNTY BRANCH, LLC | 824214966 - (PA) WESTERN PA SURGERY CENTER BEAVER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $3201.00 | 1215283866 - EC LASER AND SURGERY INSTITUTE OF WI, LLC | 454182045 - (WI) EC LASER AND SURGERY INSTITUTE OF WI LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $317.00 | 1437706140 - GEISINGER-HM JOINT VENTURE, LLC | 831871064 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $607.00 | 1730410697 - SURGICAL SPECIALISTS AT PRINCETON LLC | 270749140 - (NJ) SURGICAL SPECIALISTS AT PRINCE | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $4893.00 | 1679065759 - MEMORIAL HERMANN SURGERY CENTER BRAZORIA, LLC | 830759140 - (TX) MEMORIAL HERMANN SURGERY CENTER BRAZORIA LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $200.00 | 1750844049 - FORT WORTH SURGICAL CENTER LP | 832752727 - (TX) FORT WORTH SURGICAL CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $1064.00 | 1295923670 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $557.00 | 1336209451 - SADDLE RIVER VALLEY SURGICAL CENTER LLC, SADDLE RIVER VALLEY SURGICAL CENTER LLC | 201250583 - (NJ) SADDLE RIVER VALLEY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $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 | 43121 | $525.00 | 1740210459 - SOUTH CAROLINA ENDOSCOPY CENTER | 562069531 - (SC) S.C. ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $705.00 | 1346244845 - LAKELAND SURGICAL & DIAGNOSTIC CENTER LLP | 934728316 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43121 | $376.00 | 1952336521 - CASC AQUISITION INC, CAROLINA AMBULATORY SURGERY CENTER | 810576467 - (SC) CASC AQUISITION INC | SC | 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 43121 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43121 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 43121 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 43121. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43121 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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