CPT 43276 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 • XS - Separate Structure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43276 |
National average reimbursement for CPT 43276 by major payers:
$622.69
$678.00
$700.41
$830.00
| 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 43276 | ||||||
United | 43276 | $1295.00 | 1932190170 - OCALA EYE SURGERY CENTER INC | 593323478 - (FL) OCALA EYE SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1000.00 | 1770724122 - NATIONAL SURGICAL CENTERS OF AMERICA LLC, NSCOA | 264278807 - (FL) NATIONAL SURGICAL CENTERS OF AMERICA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $519.00 | 1346469731 - AKDHC SURGERY CENTER, LLC | 753052504 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1080.00 | 1922412790 - SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC, SENTARA KITTY HAWK AMBULATORY SURGERY CENTER | 463846081 - SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $811.00 | 1811932270 - PHILADELPHIA SURGI CENTER, INC. | 232965126 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1600.00 | 1265431670 - AUBURN SURGERY CENTER INC. | 431937843 - (MO) AUBURN SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $2621.00 | 1336649565 - ADVANCED SURGICAL CARE OF ST. LOUIS, LLC | 823086965 - (MO) ADVANCED SURGICAL CARE OF ST LOUIS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1200.00 | 1891295275 - FRESENIUS VASCULAR CARE MONTGOMERY ASC LLC | 815391782 - (AL) FRESENIUS VASCULAR CARE MONTGOMERY ASC LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1030.13 | 1053360107 - ADVANCED EYE SURGERY CENTER | 204771266 | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1429.00 | 1396214938 - GRACE SURGERY CENTER LLC | 830543417 - (FL) GRACE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $2353.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $2307.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $2353.00 | 1124261771 - KHS AMBULATORY SURGERY CENTER, LLC, SELECT SURGICAL CENTER AT KENNEDY | 260715364 - (NJ) KHS AMBULATORY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1087.00 | 1740978386 - DUKE HEALTH INTEGRATED PRACTICE, INC, DUKE GI AT BRIER CREEK | 862109896 - DUKE HEALTH INTEGRATED PRACTICE INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1962.00 | 1073763652 - LEBONHEUR EAST SURGERY CENTER II LP, LEBONHEUR EAST SURGERY CENTER LP | 800247391 - (TN) LEBONHEUR EAST SURGERY CENTER II LP | TN | 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 43276 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43276 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 43276 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 |
|---|---|---|
| 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 |
| 43275-CPT | Moderate | Once Per Dos Endoscopic Retrograde Cholangiopancreatography (Ercp); W/Removal Of Foreign Body(S) Or Stent(S) From Biliary/Pancreatic Duct(S) |
| 43276-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Removal And Exchange Of Stent(S) Biliary Or Pancreatic Duct Including Pre- And Post-Dilation And Guide Wire Passage When Performed Including Sphincterotomy When Performed Each Stent Exchanged. |
| 43277-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Trans-Endoscopic Balloon Dilation Of Biliary/Pancreatic Duct(S) Or Of Ampulla (Sphincteroplasy) Including Sphincterotomy When Performed Each Duct |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43276. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43276 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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