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See a sample rate comparisonCPT 43313 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 Congenital, Esophagoplasty For Congenital Defect Plastic Repair Or Reconstruction Thoracic Approach Without Repair Of Congenital 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 11 - Office |
| Common Modifiers | 58 - Staged or related procedure during postoperative period 62 - Co-Surgeons |
| Complexity Level | High |
| Medicare Fee Schedule | $2,709.15 national non-facility rate (2026) · View Medicare rates for 43313 |
| Medicaid Fee Schedule | $2,108.83 median of the 8 states in the free preview · View Medicaid rates for 43313 |
National average reimbursement for CPT 43313 by major payers:
$3,677.22
$3,719.18
$4,054.75
$4,546.35
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CPT 43313
5 of 25 sample ratesHigher to lower in this preview
Waverley Surgery Center LLC, Waverley Surgery Center
Waverley Surgery Center, L.P.
$6,756.00Published rateSummit Surgical Associates LLC, Summit Surgical Center
Summit Surgical
$1,274.00Published rateCares Surgicenter LLC
$972.00Published rateOlympia Multi-Specialty Clinic Ambulatory Procedures Cntr PLLC
Olympia Multispecialty Clinic Ambulatory Procedures Cntr PLLC
$625.00Published rateLake Surgery & Endoscopy Center Ltd
Lake Surgery Endoscopy Center Ltd
$225.00Published rate
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See a sample payer proposalCPT 43313 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43313 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 43313 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 |
| 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43313. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43313 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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