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 |
| CMS | $1,363.73 Physician Fee Schedule |
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 | $446.00 | 1255309951 - BAYFRONT SAME DAY SURGERY CENTER, LLC. | 845074208 - (FL) OHI WEST INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $2945.00 | 1477552768 - COURT STREET SURGERY CENTER, LP | 300197423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $812.00 | 1831217231 - THE ENDOSCOPY CENTER AT BAINBRIDGE LLC | 205430025 - (OH) THE ENDOSCOPY CENTER AT BAINBRIDGE LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $624.00 | 1780851691 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $721.00 | 1669585964 - WEST LAS VEGAS SURGERY CENTER,LLC, VALLEY VIEW SURGERY CENTER | 201898649 - (NV) WEST LAS VEGAS SURGERY CENTER LLC D/B/A VALLEY VIEW SURGERY CENTER | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $1049.00 | 1902302961 - HILL COUNTRY SURGERY CENTER, LLC, SURGERY CENTER OF BOERNE | 352599588 - (TX) HILL COUNTRY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $2785.00 | 1083912745 - RED ROCKS SURGERY CENTERS, LLC | 271095323 - (CO) RED ROCKS SURGERY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $311.00 | 1063445542 - TOTAL PAIN CARE LLC | 202484443 - (MS) TOTAL PAIN CARE, LLC | MS | 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 | $1114.00 | 1023551413 - MID-BRONX ENDOSCOPY CENTER LLC | 471156630 - (NY) MIDBRONX ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $524.00 | 1972711471 - NOVI SURGERY CENTER LLC, NOVI SURGERY CENTER | 201600650 - (MI) NOVI SURGERY CENTER, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $1049.00 | 1114126596 - CORAL RIDGE OUTPATIENT CENTER LLC, CORAL RIDGE OUTPATIENT CENTER | 205429299 - (FL) CORAL RIDGE OUTPATIENT CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $862.00 | 1083686208 - WICHITA ORTHOPAEDIC ASC LLC, SURGERY CENTER OF KANSAS | 621659908 - (KS) WICHITA ORTHOPAEDIC ASC LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $1456.00 | 1366446189 - PARKWAY SURGERY CENTER, LLC., PARKWAY SURGERY CENTER | 880403777 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43320 | $1000.00 | 1427585280 - PINNACLE SURGERY CENTER, INC | 812354493 - (CA) PINNACLE SURGERY CENTER INC | CA | 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 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43320) and we'll show you how you compare in 15 minutes or less.