CPT 43289 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 43289 |
National average reimbursement for CPT 43289 by major payers:
$2,065.68
$252.45
$1,725.00
$2,356.37
| 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 43289 | ||||||
United | 43289 | $951.00 | 1346416690 - GARDEN STATE AMBULATORY SURGERY CENTER PC | 223504597 - (NJ) GARDEN STATE AMBULATORY SURGERY CENTER PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $2814.00 | 1962031807 - CVP SURGERY CENTER IVY POINTE, LLC | 311473421 - CINCINNATI EYE INSTITUTE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $5720.00 | 1316940539 - GRAND ISLAND SURGICAL CENTER LLC | 470811846 - (NE) GRAND ISLAND SURGICAL CENTER, L.L.C. | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $1509.00 | 1952364002 - SURGICARE OF CENTRAL FLORIDA LTD, CENTRAL FLORIDA SURGICENTER | 752556633 - (FL) SURGICARE OF CENTRAL FLORIDA, LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $1950.00 | 1396702528 - TALLAHASSEE NEUROSUGERY PAIN MANAGEMENT LLC, TALLAHASSEE MEMORIAL CENTER FOR PAIN MANAGEMENT | 200307088 - (FL) TALLAHASSEE NEUROSUGERY PAIN MANAGEMENT LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $1547.00 | 1962080853 - NOVANT HEALTH WILMINGTON ENDOSCOPY CENTER LLC, NOVANT HEALTH WILMINGTON ENDOSCOPY CENTER | 862943847 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $2149.00 | 1780218115 - SURGERY CENTER OF FORT WAYNE | 825163478 - (IN) SURGERY CENTER OF FORT WAYNE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $1600.00 | 1013096700 - CLEARER VISION, LLC, PERIMETER SURGERY CENTER | 621792483 - (TN) CLEARER VISION, LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $2554.00 | 1174713382 - GREENBRIER CLINIC SURGERY CENTER | 200126880 | WV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $3275.00 | 1013309459 - MELBOURNE SURGERY CENTER, LLC, MELBOURNE SURGERY CENTER | 582101921 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $5249.00 | 1295344026 - WEST CHESTER SURGICAL SUITES, LLC | 845072006 - (OH) WEST CHESTER SURGICAL SUITES LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $7124.00 | 1023071560 - MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES, L.P., MEDICAL CITY SURGERY CENTER/FORT WORTH | 621489404 - (TX) MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $6506.00 | 1518356070 - DIGESTIVE DISEASE CENTER OF AMARILLO LLC | 752893120 - (TX) AMARILLO ENDOSCOPY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $3067.00 | 1215990247 - SOUTHERN HILLS SURGERY CENTER LP, SOUTHERN HILLS SURGERY CENTER | 200533890 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43289 | $2619.00 | 1942292545 - CAPITAL REGION AMBULATORY SURGERY CENTER, L.L.C. | 141819902 - (NY) CAPITAL REGION AMBULATORY SURGERY CENTER LLC | NY | 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 43289 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43289 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 43289 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 |
|---|---|---|
| 43286-CPT | High | Esophagectomy Total Or Near Total With Laparoscopic Mobilization Of The Abdominal And Mediastinal Esophagus And Proximal Gastrectomy With Laparoscopic Pyloric Drainage Procedure If Performed With Open Cervical Pharyngogastrostomy Or Esophagogastrostomy (Ie Laparoscopic Transhiatal Esophagectomy) |
| 43287-CPT | High | 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) |
| 43288-CPT | High | Esophagectomy Total Or Near Total With Thoracoscopic Mobilization Of The Upper Middle And Lower Mediastinal Esophagus With Separate Laparoscopic Proximal Gastrectomy With Laparoscopic Pyloric Drainage Procedure If Performed With Open Cervical Pharyngogastrostomy Or Esophagogastrostomy (Ie Thoracoscopic Laparoscopic And Cervical Incision Esophagectomy Mckeown Esophagectomy Tri-Incisional Esophagectomy) |
| 43289-CPT | High | Other Procedure On Esophagus Using An Endoscope |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43289. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43289 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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