Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 43305 Fee Schedule
Last Verified: October 2026
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.
Repair Esophagus And Fistula, Esophagoplasty Plastic Repair Or Reconstruction Cervical Approach With Repair Of Tracheoesophageal Fistula
| 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 | 78 - Return to OR - related procedure 62 - Co-Surgeons |
| Complexity Level | High |
| Medicare Fee Schedule | $943.58 national non-facility rate (2026) · View Medicare rates for 43305 |
| Medicaid Fee Schedule | $760.325 median of the 8 states in the free preview · View Medicaid rates for 43305 |
National average reimbursement for CPT 43305 by major payers:
$1,377.68
$1,478.48
$1,542.40
$1,798.12
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43305.
CPT 43305
5 of 25 sample ratesHigher to lower in this preview
Greenville Surgery Center, LLC, Texas Health Surgery Center Dallas
Greenville Surgery Center LLC
$6,068.00Published rateRads Of America, LLC, Premier Radiology Pain Management Center
Rads Of America LLC
$1,196.00Published rateKingsport Tn Ophthalmology Asc LLC, The Regional Eye Surgery Center
$667.00Published rateLaser & Surgical Services At Center For Sight LLC
Laser Surgical Services At Center For Sight LLC
$420.00Published rateForest Canyon Endoscopy & Surgery Ctr PC
Forest Canyon Endoscopy & Surgery Center, PC
$100.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 43305 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43305 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 43305 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 |
|---|---|---|
| 43300-CPT | Moderate | Esophagoplasty (Plastic Repai, Esophagoplasty (Plastic Repair Or Reconstruction) Cervicalapproach Without Repair Of Tracheoesophageal Fistula |
| 43305-CPT | High | Repair Esophagus And Fistula, Esophagoplasty Plastic Repair Or Reconstruction Cervical Approach With Repair Of Tracheoesophageal Fistula |
| 43310-CPT | High | Esophagoplasty (Plastic Repai, Esophagoplasty (Plastic Repair Or Reconstruction) Thoracicapproach Without Repair Of Tracheoesophageal Fistula |
| 43313-CPT | High | Esophagoplasty Congenital, Esophagoplasty For Congenital Defect Plastic Repair Or Reconstruction Thoracic Approach Without Repair Of Congenital Tracheoesophageal Fistula |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43305. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43305 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43305) and we'll show you how you compare in 15 minutes or less.