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See a sample rate comparisonCPT 43320 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.
Esophagogastrostomy (Cardiopla, Esophagogastrostomy (Cardioplasty) With Or Without Vagotomyand Pyloroplasty Transabdominal Or Transthoracic Approach
| 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 | 80 - Assistant surgeon 78 - Return to OR - related procedure |
| Complexity Level | High |
| Medicare Fee Schedule | $1,307.98 national non-facility rate (2026) · View Medicare rates for 43320 |
| Medicaid Fee Schedule | $1,018.52 median of the 8 states in the free preview · View Medicaid rates for 43320 |
National average reimbursement for CPT 43320 by major payers:
$1,722.90
$1,858.00
$1,921.18
$2,216.43
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CPT 43320
5 of 25 sample ratesHigher to lower in this preview
Court Street Surgery Center, Lp
$2,945.00Published rateOnyx & Pearl Surgical Suites LLC
Onyx & Pearl Surgical Suites, LLC
$1,028.00Published rateNorthwest Endo Center LLC
$625.00Published rateOcala Fl Orthopaedic Asc LLC
Ocala Fl Orthopaedic Asc, LLC
$475.00Published rateRembrandt Outpatient Surgery Center PLLC, Rembrandt Outpatient Surgery Center
Rembrandt Outpatient Surgery Center PLLC
$175.00Published rate
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See a sample payer proposalCPT 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 | Repair Esophagus And Fistula, Esophagoplasty Plastic Repair Or Reconstruction Cervical Approach With Repair Of Tracheoesophageal Fistula |
| 43320-CPT | High | Esophagogastrostomy (Cardiopla, Esophagogastrostomy (Cardioplasty) With Or Without Vagotomyand Pyloroplasty Transabdominal Or Transthoracic Approach |
| 43325-CPT | High | Esophagus Surgery For Reflux, Surgery To Repair A Weakened Valve Or Muscle Between The Esophagus And The Stomach. The Procedure Relieves Acid Reflux. |
| 43330-CPT | High | Surgical Repair Of Esophagus, Surgery To Repair The Esophagus Through An Incision Into Chest (Thoracic Approach) Or Abdomen. |
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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