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See a sample rate comparisonCPT 43310 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.
Esophagoplasty (Plastic Repai, Esophagoplasty (Plastic Repair Or Reconstruction) Thoracicapproach Without 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 | 62 - Co-Surgeons 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | $1,400.50 national non-facility rate (2026) · View Medicare rates for 43310 |
| Medicaid Fee Schedule | $1,092.925 median of the 8 states in the free preview · View Medicaid rates for 43310 |
National average reimbursement for CPT 43310 by major payers:
$1,960.75
$2,027.88
$2,048.75
$2,384.04
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CPT 43310
5 of 25 sample ratesHigher to lower in this preview
Arlington Surgery Center, LLC, Arlington Surgery Center Associates, Lp
Arlington Surgery Center LLC
$6,068.00Published rateFredericksburg Ambulatory Surgery Center, LLC
Fredericksburg Ambulatory Surgery Center LLC
$1,290.00Published ratePoint Of Rocks Surgery Center, LLC
$936.00Published rateDenver Eye Surgery Center, LLC
Denver Eye Surgery Center LLC
$555.00Published rateValley Medical Group, P.C., Valley Medical Group Ambulatory Surgery & Procedures Center
Valley Medical Group, P.C.
$130.00Published rate
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See a sample payer proposalCPT 43310 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43310 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 43310 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 43310. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43310 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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