CPT 43274 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • XS - Separate Structure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43274 |
National average reimbursement for CPT 43274 by major payers:
$626.01
$651.61
$670.09
$797.57
| 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 43274 | ||||||
United | 43274 | $611.00 | 1649233719 - GI ASC LLC | 861122720 - (PA) GI ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $1950.00 | 1528572815 - SUN SURGERY CENTER HUNTINGTON LLC | 822382700 - (CA) SUN SURGERY CENTER HUNTINGTON LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $5841.00 | 1053391870 - NORTHWEST SURGERY CENTER, LTD, NORTHWEST SURGERY CENTER RED OAK | 760452319 - (TX) NORTHWEST SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $384.91 | 1740871177 - JOHN CAROCCIO | 350593390 - DEACONESS HOSPITAL INC | PA | Certified Registered Nurse Anesthetist (367500000X) |
United | 43274 | $369.00 | 1003858721 - PIEDMONT ENDOSCOPY CENTER, INC. | 561634105 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $1236.00 | 1306476197 - EAMC-LANIER AMBULATORY SURGERY CENTER, LLC | 843468862 - (AL) EAMCLANIER AMBULATORY SURGERY CENTER LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $1430.00 | 1225058068 - PROCEDURE CENTER OF IRVINE INC., PROCEDURE CENTER OF IRVINE | 330932503 - (CA) PROCEDURE CENTER OF IRVINE INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $1600.00 | 1316604440 - GEORGIA INTERVENTIONAL PAIN | 862695318 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $1356.00 | 1699246181 - DEERBROOK ASC LLC | 823478937 - (TX) DEERBROOK ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $2206.00 | 1770929044 - SURGCENTER OF PALM BEACH GARDENS, SURGCENTER OF PALM BEACH GARDENS, LLC | 462315994 - (FL) SURGCENTER OF PALM BEACH GARDENS, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $1542.00 | 1881125870 - RENAL ASSOCIATES, P.A. | 742083988 - (TX) RENAL ASSOCIATES, PA | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $837.75 | 1962451245 - SHOAIB ALAM | 350593390 - DEACONESS HOSPITAL INC | VA | Pulmonary Disease Physician (207RP1001X) |
United | 43274 | $1540.00 | 1265486849 - FEATHERSTONE PARTNERSHIP LP, ROCKFORD AMBULATORY SURGERY CENTER | 363861021 - (IL) THE FEATHERSTONE PARTNERSHIP L. P. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $1405.00 | 1487096061 - ARETE SURGICAL CENTER, LLC | 455436298 - (CO) ARETE SURGICAL CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43274 | $1420.00 | 1396700753 - HALCYON LASER & SURGERY CENTER, INC. | 770410936 - (CA) HALCYON LASER SURGERY CENTER INC | CA | 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 43274 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43274 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 43274 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) |
| 43263-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Pressure Measurement Of Sphincter Of Oddi (Revised 01/01/2014) |
| 43265-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Destruction Of Calculi Any Method (Eg Mechanical Electrohydraulic Lithotripsy) (Revised 01/01/2014) |
| 43274-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Placement Of Endoscopic Stent Into Biliary Or Pancreatic Duct Including Pre- And Post-Dilation And Guide Wire Passage When Performed Including Sphincterotomy When Performed Each Stent |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43274. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43274 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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