CPT 43312 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 • 62 - Co-Surgeons • 63 |
| Complexity Level | High |
| CMS | $1,518.67 Physician Fee Schedule |
National average reimbursement for CPT 43312 by major payers:
$2,001.02
$2,197.75
$2,219.20
$2,617.15
| 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 43312 | ||||||
United | 43312 | $343.00 | 1386619708 - ORLANDO FL ENDOSCOPY ASC LLC, CENTRAL FLORIDA SURGICAL CENTER | 202873015 - ORLANDO FL ENDOSCOPY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $2736.73 | 1205030731 - PIERCE STREET SAME DAY SURGERY, LC, PIERCE STREET SAME DAY SURGERY, LC | 205895205 - (IA) PIERCE STREET SAME DAY SURGERY | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $297.00 | 1295793974 - SANTA LUCIA SURGICAL CENTER LLC | 201918525 - (FL) SANTA LUCIA SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $526.00 | 1871538140 - INLAND EYE SPECIALISTS A MEDICAL CORP, INLAND EYE SPECIALISTS | 330585144 - (CA) INLAND EYE SPECIALISTS, A MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $485.00 | 1952373086 - CRYSTAL RIVER ENDOSCOPY ASC LP, CITRUS ENDOSCOPY & SURGERY CENTER | 621666148 - (FL) CRYSTAL RIVER ENDOSCOPY ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $283.00 | 1538635859 - SEARCY AMBULATORY SURGERY CENTER LLC | 830756271 - (AR) SEARCY AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $758.00 | 1932718822 - CHARLES REGIONAL SURGICAL CENTER LLC | 833560882 - (MD) CHARLES REGIONAL SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $835.00 | 1033105960 - SURGERY CENTER OF OAK RIDGE, LLC, ADVANCED FAMILY SURGERY CENTER | 621801416 - (TN) ADVANCED FAMILY SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $775.00 | 1922625995 - NATIONAL SURGICAL CENTERS STOCKTON, LLC | 842979070 - (CA) NATIONAL SURGICAL CENTERS STOCKT | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $8891.00 | 1013493824 - ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO, LURIE CHILDREN'S SURGERY CENTER IN NORTHBROOK | 362170833 - ANN & ROBERT H LURIE CHILDRENS HOSPITAL OF CHICAGO | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $2575.00 | 1922075167 - NORTH CENTRAL METHODIST ASC, LP, METHODIST AMBULATORY SURGERY CENTER NORTH CENTRAL | 742998447 - (TX) NORTH CENTRAL METHODIST ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $200.00 | 1679025449 - DIGESTIVE HEALTH COMPLEX | 262808532 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $1112.00 | 1780673327 - LAKEWOOD SURGERY CENTER, LLC | 371470145 - (NJ) LAKEWOOD SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $200.00 | 1528453396 - SOUTH POINTE SURGICAL CENTER | 465558778 - (UT) SOUTH POINTE SURGICAL CENTER, LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43312 | $6068.00 | 1982716106 - THR/STT SOUTHLAKE ASC, LLC | 201728912 - (TX) THRSTT SOUTHLAKE ASC LLC | TX | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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 | Esophagoplasty Thoracic App/W Repair Tra |
| 43313-CPT | High | Esophagoplasty For Congenital Defect (Plastic Repair Or Reconstruction), Thoracic Approach; Without Repair Of Congenital Tracheoesophageal Fistula |
| 43314-CPT | High | Esophagoplasty For Congenital Defect (Plastic Repair Or Reconstruction), Thoracic Approach; With Repair Of Congenital Tracheoesophageal Fistula |
| 43320-CPT | High | Esophagogastrostomy Abd Appr |
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43312) and we'll show you how you compare in 15 minutes or less.