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See a sample rate comparisonCPT 43312 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 Thoracic 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 | 62 - Co-Surgeons 63 |
| Complexity Level | High |
| Medicare Fee Schedule | $1,478.66 national non-facility rate (2026) · View Medicare rates for 43312 |
| Medicaid Fee Schedule | $1,168.165 median of the 8 states in the free preview · View Medicaid rates for 43312 |
National average reimbursement for CPT 43312 by major payers:
$2,001.02
$2,197.75
$2,219.20
$2,561.46
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CPT 43312
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Southwest Fort Worth
$11,727.00Published rateDesert Ridge Outpatient Surgery LLC
$1,064.00Published rateSurgery Center Of Oak Ridge, LLC, Advanced Family Surgery Center
Advanced Family Surgery Center
$835.00Published rateOcala Endoscopy Asc Lp, Endoscopy Center Of Ocala
Ocala Endoscopy Asc Lp
$525.00Published rateValley Outpatient Surgical Center Inc
$100.00Published rate
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See a sample payer proposalCPT 43312 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43312 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 43312 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 |
|---|---|---|
| 43312-CPT | High | Repair Esophagus And Fistula, Esophagoplasty Plastic Repair Or Reconstruction Thoracic Approach With 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 |
| 43314-CPT | High | Tracheo Esophagoplasty Cong, Esophagoplasty For Congenital Defect Plastic Repair Or Reconstruction Thoracic Approach With Repair Of Congenital Tracheoesophageal Fistula |
| 43320-CPT | High | Esophagogastrostomy (Cardiopla, Esophagogastrostomy (Cardioplasty) With Or Without Vagotomyand Pyloroplasty Transabdominal Or Transthoracic Approach |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43312. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43312 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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