CPT 43279 Fee Schedule
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.
| 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 • AS - PA/NP/CNS assistant at surgery • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43279 |
National average reimbursement for CPT 43279 by major payers:
$1,604.76
$1,742.47
$1,866.83
$2,119.57
| 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 43279 | ||||||
United | 43279 | $7655.00 | 1922576818 - GREATER NEW HAVEN ASC, LLC | 814648930 - (CT) GREATER NEW HAVEN ASC LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $2692.00 | 1295714301 - ENDOSCOPY CENTER OF SOUTHEAST TEXAS LP, ENDOSCOPY CENTER OF SOUTHEAST TEXAS | 621536529 - (TX) ENDOSCOPY CENTER OF SOUTHEAST TEXAS LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $6588.00 | 1285815522 - TLC ASC, LLC, KZMSS AGAIN, LLLP | 201952603 - (FL) TLC ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $3800.00 | 1588679179 - SPECIALTY SURGICAL CENTER OF ENCINO LP | 954816334 - (CA) SPECIALTY SURGICAL CENTER OF ENCINO, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $1900.00 | 1588029870 - PACIFIC GASTROENTEROLOGY PLLC | 201377401 - (WA) PACIFIC GASTROENTEROLOGY, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $1339.00 | 1073818654 - ROYAL OAK SURGICAL CENTER, LLC, ROYAL OAK SURGICAL CENTER PLLC | 320323562 - (MI) ROYAL OAK SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $3200.00 | 1609949551 - NORTHWEST VISION INSTITUTE, PLLC, NORTHWEST LASER AND SURGERY CENTER | 383807987 - (WA) NORTHWEST VISION INSTITUTE, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $7229.00 | 1871032680 - OLIVE AMBULATORY SURGERY CENTER, LLC, NORTH CAMPUS SURGERY CENTER | 203834012 - (MO) OLIVE AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $1466.00 | 1942485305 - 9106 PHILADELPHIA ROAD AMBULATORY SURGERY CENTER LLC | 261539834 - (MD) 9106 PHILADELPHIA ROAD AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $856.00 | 1225199482 - ST MARKS SURGICAL CENTER LLC | 364577700 - (FL) ST MARKS SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $3275.00 | 1811387368 - AUA SURGICAL CENTER, LLC | 471131186 - (TX) AUA SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $7620.00 | 1033714001 - SURGERY CENTER AT SOUTH OGDEN, LLC | 854070407 - (UT) SURGERY CENTER AT SOUTH OGDEN LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $3800.00 | 1306851902 - SPECIALTY SURGICAL CENTER OF IRVINE LP | 571149464 - (CA) SPECIALTY SURGICAL CENTER OF IRVINE, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $2410.00 | 1740529064 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43279 | $8087.00 | 1083644124 - MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP, MEMORIAL HERMANN SURGERY CENTER SOUTHWEST | 202866884 - (TX) MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP | TX | 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 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, Surgical, Esophagomyotomy (Heller Type), With Fundoplasty, When Performed |
| 43280-CPT | High | Laparoscopy, Surgical; Esophogogastric Fundoplasty |
| 43281-CPT | High | Laparoscopy, Surgical, Repair Of Paraesophageal Hernia, Includes Fundoplasty, When Performed; Without Implantation Of Mesh |
| 43282-CPT | High | Laps Rpr Paraesphgl Hrna Incl Fundplsty W Mesh |
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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