CPT 43281 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 • 59 - Distinct Procedural Service • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43281 |
National average reimbursement for CPT 43281 by major payers:
$1,865.82
$2,129.64
$2,240.37
$2,562.87
| 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 43281 | ||||||
United | 43281 | $4468.06 | 1639268808 - MYRA MURAMOTO | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Family Medicine Physician (207Q00000X) |
United | 43281 | $6531.50 | 1205417276 - CARINA VENTER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Registered Dietitian (133V00000X) |
United | 43281 | $4581.79 | 1760749790 - TREVOR HAWKINS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Neurology Physician (2084N0400X) |
United | 43281 | $3275.00 | 1548837503 - HOUSTON IVF MANAGEMENT | 841602243 - (TX) HOUSTON IVF MANAGEMENT CO., LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43281 | $2599.60 | 1689204711 - SARA BOZZI | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Anesthesiologist Assistant (367H00000X) |
United | 43281 | $2373.03 | 1033600465 - PAIGE NAYLOR | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Clinical Neuropsychologist (103G00000X) |
United | 43281 | $5717.50 | 1063947612 - ALLISON BAKER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | AL | Ophthalmic Plastic and Reconstructive Surgery Physician (207WX0200X) |
United | 43281 | $5717.50 | 1780601229 - STEVEN EDMUNDOWICZ | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Gastroenterology Physician (207RG0100X) |
United | 43281 | $4468.06 | 1356803910 - NAINITA MADURAI | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Family Medicine Physician (207Q00000X) |
United | 43281 | $2599.60 | 1558980540 - PHEBE ABRAHAM | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Internal Medicine Physician (207R00000X) |
United | 43281 | $4468.06 | 1316924822 - BRIAN SHAW | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Orthopaedic Surgery Physician (207X00000X) |
United | 43281 | $5361.68 | 1134566003 - ASHLEY MAZO | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Emergency Medicine (Pediatrics) Physician (2080P0204X) |
United | 43281 | $5231.70 | 1619296258 - KATHERINE HUSTON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | NY | Pediatric Emergency Medicine (Pediatrics) Physician (2080P0204X) |
United | 43281 | $6531.50 | 1558932384 - DANIEL WOOD | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Urology Physician (2088P0231X) |
United | 43281 | $6531.50 | 1336465129 - SHERRENE MILLS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Medical Physician Assistant (363AM0700X) |
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 43281 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43281 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 43281 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 43281. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43281 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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