CPT 43123 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 • 19 - Off Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 62 - Co-Surgeons • 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43123 |
National average reimbursement for CPT 43123 by major payers:
$5,529.97
$5,819.45
$6,165.93
$7,061.83
| 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 43123 | ||||||
United | 43123 | $631.00 | 1659842128 - MILESTONE SURGICAL CENTER LLC | 824967929 - (CO) MILESTONE SURGICAL CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $63.00 | 1407004534 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $1262.00 | 1053835058 - CEI PHYSICIANS PSC LLC, CVP SURGERY CENTER | 311473421 - CINCINNATI EYE INSTITUTE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $983.00 | 1326527680 - INTRACOASTAL SURGERY CENTER, LLC | 824525706 - (FL) INTRACOASTAL SURGERY CENTER LL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $467.00 | 1023343720 - HATTIESBURG SURGERY CENTER, LLC | 263789784 - (MS) HATTIESBURG SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $1064.00 | 1720530405 - GRAND RAPIDS SURGICAL SUITES LLC | 811321919 - (MI) GRAND RAPIDS SURGICAL SUITES, PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $1124.00 | 1760907919 - BANNER SUN CITY WEST SURGERY CENTER LLC | 901182684 - (AZ) BANNER SUN CITY WEST SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $1274.00 | 1891175188 - PHOENIX SPINE GOODYEAR ASC, LLC, PHOENIX SPINE SURGERY CENTER | 562311366 - (AZ) PHOENIX SPINE GOODYEAR, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $2732.00 | 1912993833 - SURGICENTER OF KANSAS CITY, LLC | 431828920 - (MO) SURGICENTER OF KANSAS CITY, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $1274.00 | 1932735677 - PARKCREEK ASC LLC | 843082809 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $975.00 | 1659463669 - ARUSHA LLC, THE SURGERY CENTER OF CHESTER COUNTY | 233076222 - (PA) ARUSHA LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $969.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $6068.00 | 1982716106 - THR/STT SOUTHLAKE ASC, LLC | 262429878 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $1137.00 | 1497706626 - CHICAGO PROSTATE CANCER SURGERY CENTER, LLC, DUPAGE MEDICAL GROUP SURGERY CENTER, WESTMONT | 204403852 - (IL) CHICAGO PROSTATE CANCER SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $1049.00 | 1124261771 - KHS AMBULATORY SURGERY CENTER, LLC, SELECT SURGICAL CENTER AT KENNEDY | 260715364 - (NJ) KHS AMBULATORY SURGERY CENTER LLC | NJ | 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 43123 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43123 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 43123 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 43123. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43123 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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