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See a sample rate comparisonCPT 43135 Fee Schedule
Last Verified: October 2026
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.
Diverticulctomy Of Hypopharynx Or Esophag W//W/O Myotomy;, Diverticulectomy Of Hypopharynx Or Esophagus With Or Without Myotomy;
| 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 | AS - PA/NP/CNS assistant at surgery GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | $1,388.48 national non-facility rate (2026) · View Medicare rates for 43135 |
| Medicaid Fee Schedule | $1,075.94 median of the 8 states in the free preview · View Medicaid rates for 43135 |
National average reimbursement for CPT 43135 by major payers:
$1,862.21
$1,943.38
$2,027.60
$2,306.33
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CPT 43135
5 of 25 sample ratesHigher to lower in this preview
Arlington Surgery Center, LLC, Arlington Surgery Center Associates, Lp
Arlington Surgery Center LLC
$6,068.00Published rateBay Area Endoscopy Center LLC
$1,274.00Published rateDreyer Ambulatory Surgery Center, LLC
Dreyer Ambulatory Surgery Center LLC
$782.00Published rateMidwest Eye Surgery Center, LLC
Midwest Eye Surgery Center LLC
$603.00Published rateArizona Digestive Center, P.C.
Arizona Digestive Center PC
$90.00Published rate
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See a sample payer proposalCPT 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 Removal Of Esophagus, Partial Esophagectomy Distal Two Thirds With Thoracotomy Only With Or Without Proximal Gastrectomy With Thoracic Esophagogastrostomy With Or Without Pyloroplasty |
| 43122-CPT | High | Partial Removal Of Esophagus, Partial Esophagectomy Thoracoabdominal Or Abdominal Approach With Or Without Proximal Gastrectomy With Esophagogastrostomy With Or Without Pyloroplasty |
| 43130-CPT | Moderate | Diverticulctomy Of Hypopharynx Or Esophag W//W/O Myotomy;, Diverticulectomy Of Hypopharynx Or Esophagus With Or Without Myotomy; |
| 43135-CPT | High | Diverticulctomy Of Hypopharynx Or Esophag W//W/O Myotomy;, Diverticulectomy Of Hypopharynx Or Esophagus With Or Without Myotomy; |
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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