CPT 43180 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 22 - Increased Procedural Services |
| Complexity Level | Moderate |
| CMS | $535.34 Physician Fee Schedule |
National average reimbursement for CPT 43180 by major payers:
$754.90
$761.86
$791.28
$933.89
| 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 43180 | ||||||
United | 43180 | $2206.00 | 1326114869 - EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY, LLC | 201482218 - (TX) EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $2031.00 | 1023734084 - WEST GEORGIA SURGERY CENTER, LLC | 833671516 - (GA) TANNER MEDICAL CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $549.00 | 1801993217 - EYE PHYSICIANS OF SUSSEX COUNTY, EYE PHYSICIANS OF SUSSEX COUNTY SURGICAL SUITE | 222172159 - (NJ) EYE PHYSICIANS OF SUSSEX COUNTY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $2307.00 | 1750565594 - PEDIATRIC SURGERY CENTER -ODESSA, LLC | 651274446 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $1102.00 | 1780865634 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND TERAPEUTIC CENTER | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $2206.00 | 1871594275 - DESTIN SURGERY CENTER LLC | 593723179 - (FL) DESTIN SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $2353.00 | 1093085904 - ARIZONA ADVANCED ENDOSCOPY LLC | 453051125 - (AZ) ARIZONA ADVANCED ENDOSCOPY, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $3300.00 | 1790721769 - SAN FRANCISCO SURGERY CENTER, LP | 870689493 - (CA) SAN FRANCISCO SURGERY CENTER, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $916.00 | 1619065273 - SHENANDOAH TX ENDOSCOPY ASC LLC, WOODLANDS ENDOSCOPY CENTER | 205301383 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $2859.00 | 1245711803 - SURGCENTER CLEARWATER, LLC, SURGCENTER DUNEDIN | 823682684 - (FL) SURGCENTER CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $1050.00 | 1316499452 - COLONIE ASC LLC, SPECIALTY EYE SURGERY & LASER CENTER OF THE CAPITAL REGION | 811964670 - (NY) COLONIE ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $1403.00 | 1740787068 - CLEVELAND CLINIC FLORIDA (A NONPROFIT CORPORATION), CLEVELAND CLINIC FLORIDA CORAL SPRINGS ASC | 650003177 - CLEVELAND CLINIC FLORIDA A NONPROFIT CORPORATION | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $600.00 | 1992941462 - NORTHWEST ENDOSCOPY CENTER, LLC, NORTH WEST ENDOSCOPY CENTER | 364644974 - (GA) NORTHWEST ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $908.00 | 1043497019 - PIKESVILLE MD ENDOSCOPY ASC LLC, ENDOCENTRE OF BALTIMORE | 261467040 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43180 | $497.00 | 1316946106 - CHARLESTON ENDOSCOPY CENTER | 571104687 - (SC) CHARLESTON ENDOSCOPY CENTER | SC | 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 43180 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43180 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 43180 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 |
|---|---|---|
| 43130-CPT | Moderate | Diverticulect Hypophar/Esophag Cerv |
| 43135-CPT | High | Diverticulect Hypophar/Esophag Thor |
| 43180-CPT | Moderate | Esophagoscopy, Rigid, Transoral With Diverticulectomy Of Hypopharynx Or Cervical Esophagus (Eg, Zenker S Diverticulum), With Cricopharyngeal Myotomy, Includes Use Of Telescope Or Operating Microscope And Repair, When Performed |
| 43191-CPT | Moderate | Esophagoscopy, Rigid, Transoral; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing When Performed (Separate Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43180. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43180 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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