CPT 43280 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 80 - Assistant surgeon |
| Complexity Level | High |
| CMS | $1,050.94 Physician Fee Schedule |
National average reimbursement for CPT 43280 by major payers:
$1,357.59
$1,449.05
$1,575.61
$1,766.00
| 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 43280 | ||||||
United | 43280 | $4227.00 | 1912678947 - ECCS ACQUISITION COMPANY LLC | 352656413 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $4500.00 | 1518549393 - IREDELL PHYSICIAN NETWORK, LLC, IREDELL SURGERY AT MOORESVILLE ASC | 263853529 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $3240.00 | 1407023161 - SOUTHWEST MINNESOTA SURGICAL CENTER, INC. | 261451498 - (MN) SOUTHWEST MINNESOTA SURGICAL CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $1494.00 | 1396193033 - NEW BERLIN MEDICAL SERVICES, LLC | 811190440 - (WI) NEW BERLIN MEDICAL SERVICES LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $3381.00 | 1528622321 - PREMIER-COVENANT ASTC LLC, PREMIER AMBULATORY SURGERY CENTER | 834550993 - (TN) PREMIERCOVENANT ASTC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $1324.00 | 1679566582 - FOREST CANYON ENDOSCOPY & SURGERY CTR PC | 460504121 - (AZ) FOREST CANYON ENDOSCOPY & SURGERY CENTER, PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $748.00 | 1205303930 - LASER SURGERY HOLDING COMPANY, LTD | 550882748 - (AZ) LASER SURGERY HOLDING COMPANY LT | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $6588.00 | 1548241623 - GASTROENTEROLOGY ASSOCIATES, LLC, GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER | 912104493 - (WA) GASTROENTEROLOGY ASSOCIATES PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $8818.00 | 1245768209 - TEXAS HEALTH SURGERY CENTER BEDFORD, LLC, TEXAS HEALTH SURGERY CENTER BEDFORD | 821307876 - (TX) TEXAS HEALTH SURGERY CENTER BEDFORD LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $8200.00 | 1598417875 - ESSENTIA HEALTH SURGERY CENTERS-DULUTH LLC, ESSENTIA HEALTH SURGERY CENTER-MILLER HILL | 874339770 - (MN) ESSENTIA HEALTH SURGERY CENTERSDULUTH LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $6492.00 | 1871751859 - WESTMINSTER SURGERY CENTER | 262059600 - (MD) WESTMINSTER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $6492.00 | 1811515034 - SALMON SURGERY CENTER LLC | 844895716 - (WA) SALMON SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $2864.00 | 1528016789 - HAMILTON SURGERY CENTER L.L.C., SURGER CENTER AT HAMILTON | 830358914 - (NJ) HAMILTON SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $4328.00 | 1649944521 - PRECISION BONE AND JOINT SURGERY CENTER | 861302912 - (FL) PRECISION BONE AND JOINT SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $3888.00 | 1184660151 - INNOVATIVE PROCEDURAL CENTER LLC | 200327828 - (SD) INNOVATIVE PROCEDURE CENTER LLC | SD | 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 43280 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43280 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 43280 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 |
| 43285-CPT | Moderate | Removal Of Augmentation Device From Sphincter Of Esophagus Using A Flexible Endoscope Via Mouth |
| 43287-CPT | High | Esophagectomy Distal Two-Thirds With Laparoscopic Mobilization Of The Abdominal And Lower Mediastinal Esophagus And Proximal Gastrectomy With Laparoscopic Pyloric Drainage Procedure If Performed With Separate Thoracoscopic Mobilization Of The Middle And Upper Mediastinal Esophagus And Thoracic Esophagogastrostomy (Ie Laparoscopic Thoracoscopic Esophagectomy Ivor Lewis Esophagectomy) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43280 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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