CPT 43135 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 • AS - PA/NP/CNS assistant at surgery • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43135 |
National average reimbursement for CPT 43135 by major payers:
$1,862.21
$1,943.38
$2,027.60
$2,354.70
| 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 43135 | ||||||
United | 43135 | $775.00 | 1285889378 - PARADIGM CLINICAL ASSOCIATES LLC, STRATHAM AMBULATORY SURGERY CENTER | 262382365 - (NH) PARADIGM CLINICAL ASSOCIATES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $1049.00 | 1245711803 - SURGCENTER CLEARWATER, LLC, SURGCENTER DUNEDIN | 823682684 - (FL) SURGCENTER CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $782.00 | 1396896684 - DREYER AMBULATORY SURGERY CENTER, LLC | 363890298 - (IL) DREYER AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $5554.00 | 1659301794 - MEMORIAL HERMANN SURGERY CENTER TEXAS MEDICAL CENTER, LLP, MEMORIAL HERMANN SURGERY CENTER TEXAS MEDICAL CENTER | 203233666 - (TX) MEMORIAL HERMANN SURGERY CENTER TEXAS MEDICAL CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $775.00 | 1528462819 - THE ENDOSCOPY CENTER, INC. | 471907162 - (CA) THE ENDOSCOPY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $2228.00 | 1184814782 - PUNXSUTAWNEY AREA HOSPITAL INC | 250965210 - (PA) PUNXSUTAWNEY AREA HOSPITAL INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $1274.00 | 1295142511 - BAY AREA ENDOSCOPY CENTER LLC | 463916191 - (CA) BAY AREA ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $543.00 | 1356429765 - ASC OF GEORGIA DERMATOLOGIC SURGERY, ASC OF BAUCOM & MINA DERM SURGERY | 550892029 - (GA) ASC OF GEORGIA DERMATOLOGIC SURGERY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $800.00 | 1982931465 - GARDEN GROVE SURGICAL CENTER INC | 271203227 - (CA) GARDEN GROVE SURGICAL CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $418.00 | 1285944504 - NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK, LLC | 272840356 - (MD) NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $840.00 | 1538124490 - CITRUS REGIONAL SURGERY CENTER LP | 621510209 - (FL) CITRUS REGIONAL SURGERY CENTER LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $492.00 | 1093088304 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC ASC SEDONA | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $817.00 | 1083711568 - NATRAJ SURGERY CENTER INC. | 201290128 - (CA) NATRAJ SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $1274.00 | 1063092047 - TAMPA BAY JOINT AND SPINE, LLC, TAMPA BAY JOINT AND SPINE SURGERY CENTER | 851259146 - (FL) TAMPA BAY JOINT AND SPINE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $684.00 | 1902043284 - AESTHETIC & GENERAL DERMATOLOGY OF SEATTLE | 911886576 - (WA) ELIE LEVY, M.D., P.C. DBA AESTHETIC & GENERAL DERMATOLOGY OF SEATTLE | WA | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 43135 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43135 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 43135 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 |
|---|---|---|
| 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 |
| 43130-CPT | Moderate | Diverticulect Hypophar/Esophag Cerv |
| 43135-CPT | High | Diverticulect Hypophar/Esophag Thor |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43135. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43135 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43135) and we'll show you how you compare in 15 minutes or less.