CPT 43305 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 • 78 - Return to OR - related procedure • 62 - Co-Surgeons |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43305 |
National average reimbursement for CPT 43305 by major payers:
$1,377.68
$1,478.48
$1,542.40
$1,838.34
| 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 43305 | ||||||
United | 43305 | $420.00 | 1194813303 - LASER & SURGICAL SERVICES AT CENTER FOR SIGHT LLC | 650974511 - (FL) LASER SURGICAL SERVICES AT CENTER FOR SIGHT LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $4949.00 | 1538179551 - HENRY FORD MEDICAL CENTER FAIRLANE, HENRY FORD HEALTH SYSTEM | 381357020 - HENRY FORD HEALTH SYSTEM | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $158.00 | 1356311419 - RIVERSIDE AMBULATORY SURGERY CENTER LLC | 522233625 - (MD) RIVERSIDE AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $371.00 | 1437232758 - SHADY GROVE REPRODUCTIVE SCIENCE CENTER PC, SGFC SURGERY CENTER | 208131466 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $1188.00 | 1104233014 - TAMPA MINIMALLY INVASIVE SPINE SURGERY CENTER, LLC | 471211888 - (FL) TAMPA MINIMALLY INVASIVE SPINE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $6068.00 | 1588629604 - GREENVILLE SURGERY CENTER, LLC, TEXAS HEALTH SURGERY CENTER DALLAS | 742411643 - (TX) GREENVILLE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $544.00 | 1114923471 - SURGICARE CENTER OF IDAHO, LLC | 820513482 - (ID) SURGICARE CENTER OF IDAHO LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $667.00 | 1649244211 - KINGSPORT TN OPHTHALMOLOGY ASC LLC, THE REGIONAL EYE SURGERY CENTER | 331031979 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $6068.00 | 1619093218 - CLEBURNE SURGICAL CENTER, LLC | 203742012 - (TX) CLEBURNE SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $1064.00 | 1558618116 - TAVARES SURGERY LLC | 300728155 - (FL) TAVARES SURGERY LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $637.00 | 1861663098 - ASCENT SURGERY CENTER, LLC | 262011928 - (CO) ASCENT SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $1196.00 | 1619071214 - RADS OF AMERICA, LLC, PREMIER RADIOLOGY PAIN MANAGEMENT CENTER | 200597581 - (TN) RADS OF AMERICA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $568.00 | 1679149330 - ADVANCED SURGICAL CARE OF MARYLAND, LLC | 861991275 - (MD) ADVANCED SURGICAL CARE OF MARYLAND LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $1285.00 | 1942722798 - DREXEL TOWN SQUARE SURGERY CENTER, LLC, DREXEL TOWN SQUARE SURGERY CENTER | 814904300 - (WI) DREXEL TOWN SQUARE SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43305 | $351.00 | 1710290606 - GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER, GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER | 271921975 - (GA) GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER | GA | 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 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 Cervical Wo Rep Fist |
| 43305-CPT | High | Esophagoplasty Cervical W Rep Fist |
| 43310-CPT | High | Esophagoplasty Thoracic Wo Rep Fist |
| 43313-CPT | High | 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.
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