CPT 43291 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 • AG - Primary physician • UB |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43291 |
National average reimbursement for CPT 43291 by major payers:
$589.36
$654.97
$615.52
$790.68
| 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 43291 | ||||||
United | 43291 | $2172.00 | 1124083076 - NORTH GARLAND SURGERY CENTER LLP, BAYLOR SCOTT & WHITE SURGICARE - NORTH GARLAND | 562399993 - (TX) NORTH GARLAND SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $445.00 | 1982676227 - THE PALMETTO ASC, LLC, THE PALMETTO SURGERY CENTER | 621647406 - (FL) THE PALMETTO SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $1276.00 | 1841316841 - PACIFIC ENDOSCOPY CENTER, LLC | 203905706 - (HI) PACIFIC ENDOSCOPY CENTER, LLC | HI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $1052.00 | 1609815075 - ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE, LLC | 202961633 - (GA) ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $1322.00 | 1942278692 - FOLSOM OUTPATIENT SURGERY CENTER, LP, FOLSOM SURGERY CENTER | 202468634 - (CA) FOLSOM OUTPATIENT SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $1438.00 | 1730571118 - MEDSTAR MEDICAL GROUP | 462691028 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $773.00 | 1255345229 - BEACON ORTHOPAEDICS SURGERY CENTER, LLC, SUMMIT SURGERY CENTER | 311800570 - (OH) BEACON ORTHOPAEDICS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $390.00 | 1235165531 - LAKE SURGERY & ENDOSCOPY CENTER LTD | 593325730 - (FL) LAKE SURGERY ENDOSCOPY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $449.00 | 1003858721 - PIEDMONT ENDOSCOPY CENTER, INC. | 561634105 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $1258.00 | 1134126097 - PHYSICIAN'S SURGERY CENTER OF KNOXVILLE LLC | 621777892 - (TN) PHYSICIANS SURGERY CENTER OF KNOXVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $533.00 | 1528153111 - MECHANICSVILLE AMBULATORY SURGERY CENTER, LLC | 200767912 - (MD) MECHANICSVILLE AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $1100.00 | 1548844400 - SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | 863451115 - (KS) SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $592.00 | 1326176215 - ENDOSCOPY CENTER OF ST THOMAS LLC, NGS ENDOSCOPY CENTER | 621512411 - (TN) ENDOSCOPY CENTER OF ST THOMAS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $1066.00 | 1881804508 - FAIRFIELD SURGERY CENTER, LLC | 61555691 - (CT) FAIRFIELD SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43291 | $1233.00 | 1851710735 - SURGCENTER TUCSON, LLC | 462350774 - (AZ) SURGCENTER TUCSON, LLC | AZ | 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 43291 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43291 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 43291 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 |
|---|---|---|
| 43284-CPT | Moderate | Once Per Dos Laparoscopy, Surgical, Esophageal Sphincter Augmentation Procedure, Placement Of Sphincter Augmentation Device, Including Cruroplasty When Performed-Deny Inv/N10 |
| 43290-CPT | High | Esophagogastroduodenoscopy, Flexible, Transoral; With Deployment Of Intragastric Bariatric Balloon - Deny Inv/N10 |
| 43291-CPT | Moderate | Esophagogastroduodenoscopy, Flexible, Transoral; With Removal Of Intragastric Bariatric Balloon - Deny Inv/N10 |
| 43300-CPT | Moderate | Esophagoplasty Cervical Wo Rep Fist |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43291. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43291 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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