CPT 43331 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 |
| Common Modifiers | • None • 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 | View Medicare rates for 43331 |
National average reimbursement for CPT 43331 by major payers:
$1,715.25
$1,808.80
$1,853.31
$2,184.67
| 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 43331 | ||||||
United | 43331 | $420.00 | 1043396245 - WEST FLORIDA MEDICAL CENTER CLINIC PA, MEDICAL CENTER CLINIC AMBULATORY SURGICAL CENTER | 592193856 - (FL) WEST FLORIDA MEDICAL CENTER CLINIC, P.A. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $2705.00 | 1568979805 - ST DAVIDS AUSTIN AREA ASC LLC, ST . DAVID'S AUSTIN SURGERY CENTER | 611760247 - (TX) ST DAVIDS AUSTIN AREA ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $730.00 | 1043819873 - LONE TREE SURGERY CENTER, LLC | 851321160 - (CO) LONE TREE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $1461.00 | 1053381236 - METHODIST SURGERY CENTER GERMANTOWN LP | 621659904 - (TN) METHODIST SURGERY CENTER GERMANTOWN LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $250.00 | 1003036310 - MIDWEST ENDOSCOPY CENTER LLC | 208292570 - (IL) MIDWEST ENDOSCOPY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $1498.00 | 1790798668 - UNIVERSITY HOSPITALS MANAGEMENT SERVICES ORGANIZATION INC, UHHS WESTLAKE SURGERY CENTER | 341567805 - UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $2705.00 | 1952945156 - PHYSICIANS WEST SURGICENTER, LLC | 843452204 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $495.00 | 1700205150 - OHI WEST, INC, BAYFRONT HEALTH AMBULATORY SURGERY CENTER | 845074208 - (FL) OHI WEST INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $450.00 | 1033560420 - ABINGDON SURGICAL CENTER PC | 813054896 - (MD) ABINGDON SURGICAL CENTER PC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $2302.00 | 1477516961 - CENTRUM SURGERY CENTER LTD | 752546712 - (CO) CENTRUM SURGERY CENTER LTD | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $625.00 | 1194815639 - CEDAR ORTHOPAEDIC SURGERY CENTER, LLC | 200208975 - (UT) CEDAR ORTHOPAEDIC SURGERY CENTER LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $550.00 | 1629078043 - NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, LLC, OVERLAND PARK SURGERY CENTER | 364130546 - (KS) NOVAMED EYE SURGERY CENTER OF OVERLAND PARK LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $983.00 | 1548203888 - NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC, THE ORTHOPEDIC SURGERY CENTER OF ARIZONA | 202684773 - (AZ) NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $442.00 | 1669772893 - ADVANCED EYE SURGERY CENTER, L.L.C. | 273717607 - (KS) ADVANCED EYE SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43331 | $508.00 | 1194832949 - CHOICES WOMEN'S MEDICAL CENTER, INC. | 112715115 - CHOICES WOMENS MEDICAL CENTER IN | NY | 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 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.
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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