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 |
| Medicare Fee Schedule | View Medicare rates for 43280 |
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 | $2680.00 | 1073155834 - REGENCY AMBULATORY SURGERY CENTER ONE, LLC | 843154819 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $2415.00 | 1740264811 - EYES OF YORK SURGICAL CENTER LLC | 200930310 - (PA) EYES OF YORK SURGICAL CENTER LLC | PA | 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 | $3614.00 | 1588711162 - SEATTLE HAND SURGERY GROUP PC, SEATTLE HAND SURGERY UNIT, INC | 911652268 - (WA) SEATTLE HAND SURGERY GROUP, P.C. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $6095.00 | 1639694797 - UCSD CENTER FOR SURGERY OF ENCINITAS, L.P. | 822326631 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $851.00 | 1962568543 - ENDOSCOPY CENTER OF OCEAN COUNTY, LLC | 223461117 - (NJ) ENDOSCOPY CENTER OF OCEAN COUNTY, PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $1800.00 | 1467559625 - WINCHESTER EYE SURGERY CENTER, LLC | 203055242 - (VA) WINCHESTER EYE SURGERY CENTER, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $711.00 | 1023074291 - ARIZONA EYE INSTITUTE & COSMETIC LASER CENTER LLC | 860950533 - (AZ) ARIZONA EYE INSTITUTE COSMETIC LASER CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $4909.00 | 1720398167 - CROSSTOWN SURGERY CENTER LLC | 272552748 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $6492.00 | 1881697522 - RIVERSIDE PARK SURGICENTER LLC | 593106055 - (FL) RIVERSIDE PARK SURGICENTER LLC | FL | 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 | $4170.00 | 1508835299 - ALASKA DIGESTIVE CENTER, LLC | 481281732 - (AK) ALASKA DIGESTIVE CENTER LLC | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $3251.00 | 1093276859 - JACKSONVILLE OUTPATIENT SURGERY CENTER, LLC | 833910772 - (FL) JACKSONVILLE OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $1778.00 | 1023055001 - ZION AMBULATORY CENTER LLC | 203243084 - (MD) ZION AMBULATORY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43280 | $3550.00 | 1821101197 - OLYMPIA MULTI-SPECIALTY CLINIC AMBULATORY PROCEDURES CNTR PLLC | 911703278 - (WA) OLYMPIA MULTISPECIALTY CLINIC AMBULATORY PROCEDURES CNTR PLLC | WA | 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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