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See a sample rate comparisonCPT 43280 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.
Esophagus Surgery For Reflux, Surgery To Repair A Weakened Valve Or Muscle Between The Esophagus And The Stomach. The Procedure Relieves Acid Reflux.
| 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 | AS - PA/NP/CNS assistant at surgery 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | $1,012.05 national non-facility rate (2026) · View Medicare rates for 43280 |
| Medicaid Fee Schedule | $789.405 median of the 8 states in the free preview · View Medicaid rates for 43280 |
National average reimbursement for CPT 43280 by major payers:
$1,357.59
$1,449.05
$1,575.61
$1,727.43
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CPT 43280
5 of 25 sample ratesHigher to lower in this preview
Riverside Park Surgicenter LLC
$6,492.00Published ratePrecision Bone And Joint Surgery Center
$4,328.00Published rateAlderwood Surgery Center LLC
Alderwood Surgical Center
$3,229.00Published rateWinchester Eye Surgery Center, LLC
$1,800.00Published rateGastroenterology Consultants Of Tuscaloosa Inc, Tuscaloosa Endoscopy Center
$100.00Published rate
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See a sample payer proposalCPT 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 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. |
| 43285-CPT | Moderate | Rmvl Esophgl Sphnctr Dev, Removal Of Augmentation Device From Sphincter Of Esophagus Using A Flexible Endoscope Via Mouth |
| 43287-CPT | High | Esphg Dstl 2 3 W Laps Moblj, 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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