CPT 43278 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 • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43278 |
National average reimbursement for CPT 43278 by major payers:
$573.20
$611.68
$618.36
$747.93
| 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 43278 | ||||||
United | 43278 | $1041.00 | 1730113325 - DHA ENDOSCOPY LLC | 43551976 | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $2196.00 | 1043684129 - UNIVERSITY OF MARYLAND MEDICINE ASC, LLC, UNIVERSITY OF MARYLAND SURGERY CENTER | 472525050 - (MD) UNIVERSITY OF MARYLAND MEDICINE ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $2206.00 | 1649223124 - CAMP LOWELL SURGERY CENTER,LLC, CAMP LOWELL SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $2353.00 | 1083938765 - MEDICAL PARK TOWER SURGERY CENTER, LLC, MEDICAL PARK TOWER SURGERY CENTER | 270543475 - (TX) MEDICAL PARK TOWER SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $1450.00 | 1609882810 - LAGRECA EYE CLINIC PC, THE EYE CLINIC SURGICENTER LAGRECA EYE CLINIC | 320016290 - LAGRECA EYE CLINIC, PC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $811.00 | 1205963568 - BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION | 231714249 - (PA) BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $1810.00 | 1174873780 - YORKVILLE ENDOSCOPY, LLC | 460857425 - (NY) YORKVILLE ENDOSCOPY LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $1498.00 | 1184782203 - EASTERN OREGON REGIONAL SURGERY | 710881667 - (OR) EASTERN OREGON REGIONAL SURGERY | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $2859.00 | 1134431323 - BETHESDA CHEVY CHASE SURGERY CENTER, LLC | 272875760 - (MD) BETHESDA CHEVY CHASE SURGERY CEN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $2307.00 | 1366982845 - JACKSONVILLE ENDOSCOPY CENTERS LLC, JACKSONVILLE CENTER FOR ENDOSCOPY | 384016302 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $1500.00 | 1902850571 - SDM ASC LLC, DAYTIME OUTPATIENT SURGERY CENTER | 752816595 - (TX) SDM ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $646.00 | 1235394529 - ACCOMODATIVE SURGERY CENTER, L.L.C., BRECKSVILLE SURGERY CENTER | 203292823 - (OH) ACCOMODATIVE SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $575.00 | 1023015989 - TUCSON GASTROENTEROLOGY INSTITUTE, LLC | 860966257 - (AZ) TUCSON GASTROENTEROLOGY INSTITUTE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $1000.00 | 1225510159 - SOUTHWEST SURGERY CENTER LLC | 825304896 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43278 | $1698.00 | 1720001928 - CAMPBELL CLINIC SURGERY CENTER, LLC | 621826300 | 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 43278 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43278 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 43278 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 |
|---|---|---|
| 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 |
| 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. |
| 43278-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); With Ablation Of Tumor(S), Polyp(S), Or Other Lesion(S), Including Pre- And Post-Dilation And Guide Wire Passage, When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43278. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43278 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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