CPT 43277 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 43277 |
National average reimbursement for CPT 43277 by major payers:
$520.74
$535.64
$552.99
$656.35
| 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 43277 | ||||||
United | 43277 | $917.00 | 1376729715 - ENDOSCOPY ASSOCIATES OF VALLEY FORGE, LLC | 161770779 - (PA) ENDOSCOPY ASSOCIATES OF VALLEY FORGE LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $951.00 | 1578881009 - EYE LASER AND SURGERY CENTER LLC | 272376757 - (OH) EYE LASER AND SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $889.00 | 1184627978 - NOVAMED SURGERY CENTER OF ORLANDO LLC, DOWNTOWN SURGERY CENTER | 522441418 - (FL) NOVAMED SURGERY CENTER OF ORLANDO LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $2174.00 | 1649655515 - PARKWAY SURGERY CENTER, LLC, PARKWAY SURGERY CENTER AT HORIZON RIDGE | 880403777 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $1518.00 | 1427012202 - OUTPATIENT SURGICAL SERVICES LTD | 752433596 - (FL) OUTPATIENT SURGICAL SERVICES LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $2388.00 | 1790093813 - AZ WEST ENDOSCOPY CENTER LLC | 272343469 - (AZ) AZ WEST ENDOSCOPY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $2659.00 | 1124771985 - WAKEMED SURGERY CENTER | 874584595 - (NC) WAKEMED SURGERY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $1450.00 | 1225188808 - LOS ANGELES ENDOSCOPY CENTER, LOS ANGELES AMBULATORY SURGERY CENTER | 954775738 - (CA) LOS ANGELES ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $2206.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $677.00 | 1710591060 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 272910652 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $2000.00 | 1396832549 - GENESEE CARE L.L.C., THE SURGERY CENTER OF GENESEE COUNTY | 383242685 - (MI) GENESEE CARE LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $1700.00 | 1518300102 - SPRINGFIELD SURGERY CENTER, LLC | 461041413 - (NJ) SPRINGFIELD SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $1847.00 | 1417286428 - ALLIANCE SURGICAL CENTER LLC | 271367127 - (FL) ALLIANCE SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43277 | $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 | 43277 | $2353.00 | 1922510643 - OPTIMUM SPINE CENTER, LLC, PEACHTREE SPINE & PAIN PHYSICIANS | 320543789 | 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 43277 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43277 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 43277 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 |
|---|---|---|
| 43264-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Removal Of Calculi/Debris From Biliary/Pancreatic Duct(S) (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) |
| 43275-CPT | Moderate | Once Per Dos Endoscopic Retrograde Cholangiopancreatography (Ercp); W/Removal Of Foreign Body(S) Or Stent(S) From Biliary/Pancreatic Duct(S) |
| 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 43277. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43277 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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