CPT 43320 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 • 24 - Ambulatory Surgical Center • 11 - Office |
| Common Modifiers | • None • 80 - Assistant surgeon • 78 - Return to OR - related procedure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43320 |
National average reimbursement for CPT 43320 by major payers:
$1,722.90
$1,858.00
$1,921.18
$2,266.29
| 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 43320 | ||||||
United | 43320 | $475.00 | 1760847792 - OCALA FL ORTHOPAEDIC ASC LLC | 472831130 - (FL) OCALA FL ORTHOPAEDIC ASC, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $758.00 | 1164771762 - MARYLAND SPECIALTY SURGERY CENTER, LLC | 454793230 - (MD) MARYLAND SPECIALTY SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $581.00 | 1184690570 - PAIN CARE SURGERY, PC | 371379699 - (IL) PAIN CARE SURGERY PC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $625.00 | 1003260498 - NORTHWEST ENDO CENTER LLC | 812338623 - (IL) NORTHWEST ENDO CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $475.00 | 1881193183 - SOUTHSIDE SPECIALTY SURGICAL CENTER LLC | 823920550 - (TX) SOUTHSIDE SPECIALTY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $175.00 | 1164930731 - REMBRANDT OUTPATIENT SURGERY CENTER PLLC, REMBRANDT OUTPATIENT SURGERY CENTER | 822368976 - (AZ) REMBRANDT OUTPATIENT SURGERY CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $200.00 | 1033210760 - CARLISLE ENDOSCOPY CENTER, LTD. | 251871866 - (PA) CARLISLE ENDOSCOPY CENTER LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $618.00 | 1164584066 - NAPERVILLE SURGICAL CENTRE LLC | 200433367 - (IL) NAPERVILLE SURGICAL CENTRE, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $2705.00 | 1649931072 - MEDICAL CITY SPECIALTY SURGICENTER OF DALLAS, LLC, MEDICAL CITY ORTHOPEDIC & SPINE SURGERY CENTER DALLAS | 842824507 - (TX) MEDICAL CITY SPECIALTY SURGICENTER OF DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $600.00 | 1134135213 - MORGANTON EYE PHYSICIANS, P.A., SURGERY CENTER OF MORGANTON EYE PHYSICIANS | 561109834 - (NC) MORGANTON EYE PHYSICIANS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $1028.00 | 1699284018 - ONYX & PEARL SURGICAL SUITES LLC | 821183739 - (OH) ONYX & PEARL SURGICAL SUITES, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $341.00 | 1083920151 - HILLMOOR EYE SURGERY CENTER, LLC, ONE DAY SURGERY | 273127763 - (FL) HILLMOOR EYE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $550.00 | 1013468586 - LAKEWAY AMBULATORY SURGERY CENTER, LLC, LAKEWAY SURGERY CENTER | 383992761 - (TX) LAKEWAY AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $580.00 | 1497740617 - LAKE COUNTY PAIN & DIAGNOSTIC | 651216636 - (OH) LAKE COUNTY PAIN DIAGNOSTIC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $450.00 | 1386632610 - LHZ LIMITED PTR, SAINT CLARE SURGERY CENTER | 341816442 - (OH) LHZ LIMITED PTR | OH | 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 43320 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43320 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 43320 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 |
|---|---|---|
| 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 |
| 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 43320. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43320 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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