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See a sample rate comparisonCPT 43284 Fee Schedule
Last Verified: October 2026
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.
Laps Esophgl Sphnctr Agmntj, Laparoscopy Surgical Esophageal Sphincter Augmentation Procedure Placement Of Sphincter Augmentation Device Ie Magnetic Band Including Cruroplasty When Performed
| 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 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $626.60 national non-facility rate (2026) · View Medicare rates for 43284 |
| Medicaid Fee Schedule | $557.785 median of the 8 states in the free preview · View Medicaid rates for 43284 |
National average reimbursement for CPT 43284 by major payers:
$829.63
$904.06
$904.29
$1,066.11
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CPT 43284
5 of 25 sample ratesHigher to lower in this preview
Rock Hill Surgery Center, LLC, Carolina Surgical Center
Rock Hill Surgery Center LLC
$22,900.00Published rateWestern Ambulatory Surgery LLC
$7,059.00Published rateGwinnett Advanced Surgery Center, LLC
$4,410.00Published ratePsa Ambulatory Surgery Center Of Killeen LLC
$2,588.00Published rateCherry Hill Women'S Center, Inc.
Cherry Hill Womens Center Inc
$1,078.00Published rate
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See a sample payer proposalCPT 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 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. |
| 43283-CPT | Moderate | Laparoscopy Surgical Esophag, Laparoscopy Surgical Esophageal Lengthening Procedure (Eg Collis Gastroplasty Or Wedge Gastroplasty) (List Separately In Addition To Code For Primary Procedure) |
| 43284-CPT | Moderate | Laps Esophgl Sphnctr Agmntj, Laparoscopy Surgical Esophageal Sphincter Augmentation Procedure Placement Of Sphincter Augmentation Device Ie Magnetic Band Including Cruroplasty When Performed |
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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