CPT 43328 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 |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 80 - Assistant surgeon |
| Complexity Level | High |
| CMS | $1,078.11 Physician Fee Schedule |
National average reimbursement for CPT 43328 by major payers:
$1,488.04
$1,611.42
$1,563.13
$1,901.66
| 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 43328 | ||||||
United | 43328 | $360.00 | 1508840893 - PARKWAY SURGERY CENTER | 621799370 - (SC) PARKWAY SURGERY CENTER, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $1145.00 | 1053336602 - VIRGINIA EYE INSTITUTE INC, VIRGINIA EYE INSTITUTE SURGERY PAVILION | 541420580 - (VA) VIRGINIA EYE INSTITUTE INC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $1955.00 | 1013227248 - TUSCAN SURGERY CENTER AT LAS COLINAS, LLC, TUSCAN SURGERY CENTER AT LAS COLINAS | 273578014 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $687.00 | 1114922192 - GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER, LLC | 680380691 - (CA) GASTROENTEROLOGY ASSOC. ENDOSCOPY CENTER, LLC. DBA REDDING ENDOSCOPY | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $9043.00 | 1225064736 - NMC SURGERY CENTER, L.P., THE SURGERY CENTER OF NACOGDOCHES | 752793512 - (TX) NMC SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $296.00 | 1356463913 - MODESTO SURGERY CENTER LLC | 770394007 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $500.00 | 1841290103 - CENTRAL FLORIDA EYE INSTITUTE PL | 421621290 - (FL) CENTRAL FLORIDA EYE INSTITUTE PL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $523.00 | 1306281563 - VIVERE HEALTH NEW ORLEANS, LLC, VIVERE AUDUBON SURGERY CENTER | 300726133 - (LA) VIVERE HEALTH NEW ORLEANS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $1028.00 | 1396342481 - PIEDMONT ASC LLC | 851448653 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $450.00 | 1194966051 - FIRST STREET SURGERY CENTER INC. | 263375664 - (CA) FIRST STREET SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $369.00 | 1730132853 - OUTPATIENT SURGERY CENTER, INC. | 204305130 - (AR) OUTPATIENT SURGERY CENTER INC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $1224.00 | 1659953636 - VCU HEALTH AMBULATORY SURGERY CENTER, LLC | 863310585 - (VA) VCU HEALTH AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $523.00 | 1124277959 - CPM SURGERY CENTER 2, LLC | 263297791 - (GA) CPM SURGERY CENTER 2 LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $596.00 | 1457695116 - SOUND PAIN ALLIANCE, MT. BAKER SURGERY CENTER | 823663428 - SOUND PAIN ALLIANCE | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43328 | $2746.00 | 1134182546 - JACKSONVILLE SURGERY CENTER, LTD | 621600402 - (FL) JACKSONVILLE SURGERY CENTER LTD | FL | 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 43328 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43328 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 43328 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 |
|---|---|---|
| 43325-CPT | High | Esophagogastric Fundoplas W Fundic Patch |
| 43327-CPT | High | Once Per Dos Esophagogastric Fundoplasty Partial Or Complete; Laparotomy |
| 43328-CPT | High | Once Per Dos Esophagogastric Fundoplasty Partial Or Complete; Thoracotomy |
| 43330-CPT | High | Esophagomyotomy W W/O Hernia Repair; Abd |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43328. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43328 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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