CPT 43284 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43284 |
National average reimbursement for CPT 43284 by major payers:
$829.63
$904.06
$904.29
$1,098.14
| 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 43284 | ||||||
United | 43284 | $7059.00 | 1447293113 - WESTERN AMBULATORY SURGERY LLC | 830303151 - (WY) WESTERN AMBULATORY SURGERY LLC | WY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $4040.00 | 1346508520 - FIRST GI ENDOSCOPY AND SURGERY CENTER LLC | 270870899 - (NJ) FIRST GI ENDOSCOPY AND SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $22900.00 | 1225064876 - ROCK HILL SURGERY CENTER, LLC, CAROLINA SURGICAL CENTER | 752562111 - (SC) ROCK HILL SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $6046.00 | 1659316917 - SUGAR LAND SURGERY CENTER LTD | 621742196 - (TX) SUGAR LAND SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $5797.00 | 1568867075 - POTOMAC VIEW SURGERY CENTER, LLC | 471352116 - (MD) POTOMAC VIEW SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $2400.00 | 1407016561 - THOMASVILLE SURGERY CENTER, INC. | 582233903 - (GA) THOMASVILLE SURGERY CENTER INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $7354.00 | 1952516684 - POTTSTOWN HOSPITAL COMPANY LLC, POTTSTOWN MEMEORIAL MEDICAL CENTER | 822132538 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $3127.00 | 1063935286 - CHESNUT INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY | 821592877 - (WA) CLINIC 5C | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $1861.00 | 1154555472 - GEORGIA RETINA SURGERY CENTER, LLC | 262303683 - (GA) GEORGIA RETINA SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $5820.00 | 1366446189 - PARKWAY SURGERY CENTER, LLC., PARKWAY SURGERY CENTER | 880403777 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $4410.00 | 1922365808 - GWINNETT ADVANCED SURGERY CENTER, LLC | 455067682 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $16164.00 | 1215060546 - TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | 751752253 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $6492.00 | 1538773890 - ASC OF TRINITY, COMPREHENSIVE OUTPATIENT JOINT AND SPINE INSTITUTE | 833008593 - (FL) ASC OF TRINITY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $12746.00 | 1902052350 - SURGERY CENTER, LLC | 263169180 - (WI) THE SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43284 | $2788.00 | 1558538231 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | 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 43284 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43284 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 43284 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 |
| 43283-CPT | Moderate | Laparoscopy, Surgical, Esophageal Lengthening Procedure (Eg, Collis Gastroplasty Or Wedge Gastroplasty) (List Separately In Addition To Code For Primary Procedure) |
| 43284-CPT | Moderate | Once Per Dos Laparoscopy, Surgical, Esophageal Sphincter Augmentation Procedure, Placement Of Sphincter Augmentation Device, Including Cruroplasty When Performed-Deny Inv/N10 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43284. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43284 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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