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See a sample rate comparisonCPT 43279 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Laparoscopy Surg Esophagomyotomy (Heller Typ) W/ Fundoplasty, Laparoscopy Surgical Esophagomyotomy (Heller Type) With Fundoplasty
| 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 | AS - PA/NP/CNS assistant at surgery 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | $1,199.76 national non-facility rate (2026) · View Medicare rates for 43279 |
| Medicaid Fee Schedule | $929.05 median of the 8 states in the free preview · View Medicaid rates for 43279 |
National average reimbursement for CPT 43279 by major payers:
$1,604.76
$1,742.47
$1,866.83
$2,072.12
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CPT 43279
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Southwest LLP, Memorial Hermann Surgery Center Southwest
Memorial Hermann Surgery Center Southwest LLP
$8,087.00Published rateCapital City Surgery Center Of Florida LLC
$6,588.00Published rateConway Cardiovascular Surgery Center, LLC
Conway Cardiovascular Surgery Center LLC
$3,450.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$2,410.00Published rateSt Marks Surgical Center LLC
$856.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 43279 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43279 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 43279 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 |
|---|---|---|
| 43279-CPT | High | Laparoscopy Surg Esophagomyotomy (Heller Typ) W/ Fundoplasty, Laparoscopy Surgical Esophagomyotomy (Heller Type) With Fundoplasty |
| 43280-CPT | High | Esophagus Surgery For Reflux, Surgery To Repair A Weakened Valve Or Muscle Between The Esophagus And The Stomach. The Procedure Relieves Acid Reflux. |
| 43281-CPT | High | Repair Of A Stomach Hernia, Surgery To Repair A Stomach Hernia. The Protruding Stomach Is Moved Back Into Place And The Opening In The Diaphragm Is Stitched Smaller. Mesh May Be Implanted To Hold The Tissue In Place. |
| 43282-CPT | High | Repair Of A Stomach Hernia, Surgery To Repair A Stomach Hernia. The Protruding Stomach Is Moved Back Into Place And The Opening In The Diaphragm Is Stitched Smaller. Mesh May Be Implanted To Hold The Tissue In Place. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43279. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43279 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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