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 |
| CMS | $4,299.50 Physician Fee Schedule |
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 | $467.00 | 1023343720 - HATTIESBURG SURGERY CENTER, LLC | 263789784 - (MS) HATTIESBURG SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $849.00 | 1932258415 - GLENDALE ENDOSCOPY CENTER, LLC | 202837412 - (CA) GLENDALE ENDOSCOPY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $983.00 | 1881905792 - SURGCENTER PINELLAS, LLC | 271372259 - (FL) SURGCENTER PINELLAS, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $624.00 | 1457325573 - ST GEORGE ENDOSCOPY CENTER LLC, ST. GEORGE ENDOSCOPY CENTER | 43650097 - (UT) ST GEORGE ENDOSCOPY CENTER LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $1274.00 | 1104974310 - NORTHWEST SURGERY CENTER, LLP, NORTHWEST SURGERY CENTER | 205537270 - (TX) NORTHWEST SURGERY CENTER LLP | TX | 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 | $406.00 | 1831235878 - SOUTHERN CALIFORNIA STONE CENTER | 954539036 - (CA) UROLOGICAL INSTITUTE OF SOUTHERN CALIFORNIA 401(K) PLAN | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $2355.00 | 1336288703 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON ISSAQUAH ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $2732.00 | 1851354377 - MANATEE SURGICARE LTD | 752367622 - (FL) MANATEE SURGICARE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $100.00 | 1275725673 - GASTROENTEROLOGY CONSULTANTS OF TUSCALOOSA INC, TUSCALOOSA ENDOSCOPY CENTER | 630892558 | AL | 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 | $920.00 | 1801891668 - CASCADE SPINE CENTER, LLC | 113653049 - (OR) CASCADE SPINE CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $468.00 | 1962400044 - COA ASC OF FRANKLIN COUNTY LLC, COLUMBUS EYE SURGERY CENTER | 311454133 - (OH) COA ASC OF FRANKLIN COUNTY LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $1899.00 | 1275687873 - DERMATOLOGY ASSOCIATES OF KENTUCKY, PSC | 611262927 - (KY) NEW LEXINGTON CLINIC, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43123 | $675.00 | 1417294745 - COAL CREEK AMBULATORY SURGERY CENTER PC, COAL CREEK AMBULATORY SURGERY CENTER | 474079291 - (CO) COAL CREEK AMBULATORY SURGERY CENTER PC | CO | 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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