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See a sample rate comparisonCPT 43285 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.
Rmvl Esophgl Sphnctr Dev, Removal Of Augmentation Device From Sphincter Of Esophagus Using A Flexible Endoscope Via Mouth
| 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 PT - Colorectal cancer screening test; converted to diagnostic test or other procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $643.64 national non-facility rate (2026) · View Medicare rates for 43285 |
| Medicaid Fee Schedule | $547.87 median of the 8 states in the free preview · View Medicaid rates for 43285 |
National average reimbursement for CPT 43285 by major payers:
$900.27
$922.11
$931.32
$1,087.93
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CPT 43285
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC
Aurora Surgery Centers LLC
$12,899.00Published rateBanner Surgery Center
$5,846.00Published rateModesto Specialty Surgery Center, PC
Modesto Specialty Surgery Center PC
$3,350.00Published rateGreen Surgery Center LLC
$1,818.00Published rateDigestive Health Complex
$675.00Published rate
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See a sample payer proposalCPT 43285 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43285 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 43285 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 |
|---|---|---|
| 43200-CPT | Moderate | Esophagoscopy Flexible Brush, Esophagoscopy Flexible Transoral Diagnostic Including Collection Of Specimen S By Brushing Or Washing When Performed Separate Procedure |
| 43202-CPT | Moderate | Esophagus Exam With Scope, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy). |
| 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 |
| 43285-CPT | Moderate | Rmvl Esophgl Sphnctr Dev, Removal Of Augmentation Device From Sphincter Of Esophagus Using A Flexible Endoscope Via Mouth |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43285. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43285 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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