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 |
| CMS | $1,411.60 Physician Fee Schedule |
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 | $90.00 | 1336272657 - ARIZONA DIGESTIVE CENTER, P.C. | 201544723 - (AZ) ARIZONA DIGESTIVE CENTER PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $1064.00 | 1821421256 - MONOCACY SURGERY CENTER LLC | 462861862 - (MD) MONOCACY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $202.00 | 1043684129 - UNIVERSITY OF MARYLAND MEDICINE ASC, LLC, UNIVERSITY OF MARYLAND SURGERY CENTER | 472525050 - (MD) UNIVERSITY OF MARYLAND MEDICINE ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $356.00 | 1609871680 - LAUREL MD ENDOSCOPY ASC LLC, AMBULATORY ENDOSCOPY CENTER OF MARYLAND | 203959465 - (MD) LAUREL MD ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $295.00 | 1700881539 - ARTURO BETANCOURT, M.D., P.A., BALTIMORE WASHINGTON EYE CENTER | 522032553 - (MD) ARTURO BETANCOURT, MD, PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $603.00 | 1598744732 - MIDWEST EYE SURGERY CENTER, LLC | 470831193 - (NE) MIDWEST EYE SURGERY CENTER LLC | NE | 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 | $820.00 | 1457329963 - SEQUOIA SURGERY CENTER, LLC, CYPRESS SURGERY CENTER, A LIMITED PARTNERSHIP | 770326275 - (CA) SEQUOIA SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $136.00 | 1053407353 - ROC-ASC, LLP | 200932645 - (TX) ROCASC LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $450.00 | 1831349406 - GASTROENTEROLOGY EAST, P.A. | 202964888 - (NC) GASTROENTEROLOGY EAST, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $406.00 | 1689311938 - HURON GASTRO ENDOSCOPY CENTER LLC, HURON GASTRO CENTER FOR DIGESTIVE CARE | 853580801 - (MI) HURON GASTRO ENDOSCOPY CENTER LLC | MI | 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 | $726.00 | 1780076885 - MURRELLS INLET ASC LLC, CAROLINA COAST SURGERY CENTER | 454450466 - (SC) MURRELLS INLET ASC, LLC DBA CAROLINA COAST SURGERY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43135 | $1108.00 | 1851367486 - GRHS, LLC, ROCHESTER AMBULATORY SURGERY CENTER | 453685937 - (NY) ROCHESTER AMBULATORY SURGERY CENTER | NY | 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 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.
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