CPT 43124 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 62 - Co-Surgeons • 52 - Reduced Services |
| Complexity Level | High |
| CMS | $3,641.25 Physician Fee Schedule |
National average reimbursement for CPT 43124 by major payers:
$4,635.74
$4,893.20
$5,210.82
$5,959.33
| 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 43124 | ||||||
United | 43124 | $175.00 | 1144842394 - NATIONAL CARDIOVASCULAR SURGERY CENTER, LLC, PEAK SURGERY CENTER OF AVONDALE | 843454423 - (AZ) NATIONAL CARDIOVASCULAR SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $234.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $2011.00 | 1194489757 - WALNUT CREEK SURGICAL SUITES, LLC | 852525715 - (OH) WALNUT CREEK SURGICAL SUITES LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $2172.00 | 1508871211 - TEXAS DIGESTIVE DISEASE CENTER, LTD | 273578014 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $970.00 | 1699421024 - INFIRMARY ASC | 87192233 | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $983.00 | 1720530405 - GRAND RAPIDS SURGICAL SUITES LLC | 811321919 - (MI) GRAND RAPIDS SURGICAL SUITES, PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $1670.00 | 1992459978 - OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER, OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER DUBLIN | 854149946 - (OH) OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $1231.00 | 1114196151 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $104.00 | 1174258602 - APOLLO SURGERY CENTER LLC | 320689945 - (CA) APOLLO SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $573.20 | 1285746263 - ORTHOPEDICS SURGICAL CENTER OF THE NORTH SHORE LLC | 10731399 - (MA) ORTHOPEDIC SURGICAL CENTER OF THE NORTH SHORE | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $2732.00 | 1477503175 - PALMS WEST SURGERY CENTER LTD | 201008459 - (FL) PALMS WEST SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $523.00 | 1992192488 - WEST PACES SURGERY CENTER LLC | 473360333 - (GA) WEST PACES SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $200.00 | 1225510159 - SOUTHWEST SURGERY CENTER LLC | 825304896 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $233.00 | 1447442876 - MAPLE SPRINGS PODIATRIC SURGICAL CENTER, INC | 521883407 - (MD) MAPLE SPRINGS PODIATRIC SURGICAL CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43124 | $545.00 | 1811933179 - KALAMAZOO ENDO CENTER LLC | 201582174 - (MI) KALAMAZOO ENDO CENTER LLC | MI | 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 43124 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43124 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 43124 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) |
| 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) |
| 43124-CPT | High | Ttl/Part Esophgtmy, Wo Recnstrctn (Any Aprch), W/Crvcl Esophgostmy |
| 43130-CPT | Moderate | Diverticulect Hypophar/Esophag Cerv |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43124. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43124 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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