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See a sample rate comparisonCPT 43331 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.
Surgical Repair Of Esophagus, Surgery To Repair The Esophagus Through An Incision Into Chest (Thoracic Approach) Or Abdomen.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures 80 - Assistant surgeon GC - Service performed by resident under supervision AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | $1,282.26 national non-facility rate (2026) · View Medicare rates for 43331 |
| Medicaid Fee Schedule | $1,002.735 median of the 8 states in the free preview · View Medicaid rates for 43331 |
National average reimbursement for CPT 43331 by major payers:
$1,715.25
$1,808.80
$1,853.31
$2,139.06
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CPT 43331
5 of 25 sample ratesHigher to lower in this preview
North Shore Surgical Suites, LLC, North Shore Surgical Suites
North Shore Surgical Suites, LLC
$4,128.00Published rateSkyway Surgery Center, LLC
Skyway Surgery Center LLC
$1,028.00Published rateNovamed Eye Surgery Center Of Overland Park, LLC, Overland Park Surgery Center
Novamed Eye Surgery Center Of Overland Park LLC
$550.00Published rateAdvanced Eye Surgery Center, L.L.C.
Advanced Eye Surgery Center LLC
$442.00Published rateScottsdale Eye Institute, Plc, Scottsdale Eye Institute, Plc
Scottsdale Eye Institute Plc
$110.00Published rate
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See a sample payer proposalCPT 43331 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43331 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 43331 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 |
|---|---|---|
| 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. |
| 43331-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 43331. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43331 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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