CPT 43273 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 • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Low |
| CMS | $113.54 Physician Fee Schedule |
National average reimbursement for CPT 43273 by major payers:
$170.89
$168.10
$175.53
$212.81
| 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 43273 | ||||||
United | 43273 | $234.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $555.00 | 1861740508 - ADVANCED SURGERY CENTER OF SARASOTA, LLC | 454909647 - (FL) ADVANCED SURGERY CENTER OF SARASOTA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $150.00 | 1144293309 - SUNCOAST ENDOSCOPY ASC LP, SUN COAST ENDOSCOPY CENTER | 621839179 - (FL) SUNCOAST ENDOSCOPY ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $252.00 | 1891186987 - FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTER,LLC | 464426708 - (CO) FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTERLLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $70.00 | 1396828323 - EYE CARE SURGERY CENTER OF MEMPHIS, LLC | 470920340 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $180.00 | 1629313739 - COLTON CA MULTI ASC LP, PREMIER OUTPATIENT SURGERY CENTER | 461462978 - (CA) COLTON CA MULTI ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $566.00 | 1942472931 - SURGCENTER OF GLEN BURNIE, SURGCENTER OF GLEN BURNIE, LLC | 261572774 - (MD) SURGCENTER OF GLEN BURNIE, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $166.00 | 1811940141 - SOUTHPARK SURGERY CENTER LLC, SOUTHPARK SURGERY CENTER | 870714098 - (NC) SOUTHPARK SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $1446.00 | 1093383655 - SHERMAN ENDOSCOPY CENTER, LLC | 861402910 - (TX) SHERMAN ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $200.00 | 1174938344 - SPECIALTY SURGERY CENTER, LLC | 455554765 - (MS) SPECIALTY SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $6623.00 | 1356124309 - SAINT LUKE'S NORTH SURGERY CENTER, LLC | 920591506 - (MO) SAINT LUKES NORTH SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $250.00 | 1811387368 - AUA SURGICAL CENTER, LLC | 471131186 - (TX) AUA SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $245.00 | 1255342366 - MILLMAN-DERR CENTER FOR EYE CARE, P.C., MD SURGICENTER | 382184165 - (MI) MILLMAN-DERR CENTER FOR EYE CARE, P.C. | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $425.00 | 1164723011 - SURGICAL SPECIALTY CENTER OF WESTCHESTER LLC, PLASTIC SURGERY CENTER OF WESTCHESTER LLC | 273453889 - (NY) SURGICAL SPECIALTY CENTER OF WESTCHESTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43273 | $175.00 | 1871204511 - LAWRENCEVILLE CENTER FOR PAIN AND SPINE, LLC | 920689448 - (GA) LAWRENCEVILLE CENTER FOR PAIN AND SPINE LLC | GA | 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 43273 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43273 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 43273 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 |
|---|---|---|
| 43260-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed(Separate Procedure) (Revised 01/01/2014) |
| 43261-CPT | Moderate | Ercp; With Biopsy, Single Or Multiple |
| 43262-CPT | Moderate | Ercp,W/Wo Bx/Coll.Specimen;Sphincterotom |
| 43273-CPT | Low | Endoscopic Cannulation Of Papilla With Direct Visualization Of Pancreatic/Common Bile Duct(S) (List Separately In Addition To Code(S) For Primary Procedure) (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43273. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43273 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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