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 |
| CMS | $458.35 Physician Fee Schedule |
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 | $400.91 | 1992437891 - ROBIN BETZ | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
United | 43276 | $2353.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1954.00 | 1437764321 - BAPTIST HEALTH SURGERY CENTER, LLC, BAPTIST HEALTH SURGERY CENTER AT PLANTATION | 650663357 - (FL) BAPTIST HEALTH SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $2307.00 | 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 | $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 | $519.00 | 1346469731 - AKDHC SURGERY CENTER, LLC | 753052504 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $1900.00 | 1700546629 - STONE OAK SURGICENTER, LLC | 873925488 | TX | 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 | $1561.00 | 1578918124 - CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | 811657416 - (ND) CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $3993.00 | 1528339447 - CP SURGERY CENTER, LLC | 800776412 | TX | 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 | $1858.00 | 1447260575 - CENTRAL INDIANA ORTHOPEDIC SURGERY CENTER, LLC | 352033226 - (IN) CENTRAL INDIANA ORTHOPEDIC SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $2564.00 | 1336790237 - AURORA ENDOSCOPY SURGICENTER, LLC | 825396997 - (CO) AURORA ENDOSCOPY SURGICENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $3730.00 | 1114265519 - PRECISION AMBULATORY SURGERY CENTER LLC | 461628556 - (CA) PRECISION AMBULATORY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43276 | $2859.00 | 1104485440 - SURGCENTER OF GREATER JACKSONVILLE, LLC | 832504492 - (FL) SURGCENTER OF GREATER JACKSONVILLE LLC | FL | 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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