CPT 43333 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 • AS - PA/NP/CNS assistant at surgery • 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43333 |
National average reimbursement for CPT 43333 by major payers:
$1,666.60
$1,775.98
$1,758.09
$2,121.86
| 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 43333 | ||||||
United | 43333 | $420.00 | 1952917445 - AURORA SURGICAL CENTER LLC | 852607513 - (AZ) AURORA SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $1196.00 | 1619071214 - RADS OF AMERICA, LLC, PREMIER RADIOLOGY PAIN MANAGEMENT CENTER | 200597581 - (TN) RADS OF AMERICA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $850.00 | 1497173801 - EHI SURGERY CENTER AUSTIN, LLC, LEGENT OUTPATIENT SURGERY - AUSTIN | 464266877 - (TX) EHI SURGERY CENTER AUSTIN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $1607.00 | 1558328096 - NEWPORT BEACH ENDOSCOPY CENTER, LLC | 770368744 - (CA) NEWPORT BEACH ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $468.00 | 1932132065 - AMBULATORY SURGICAL CTR OF AIKEN LLC, THE SURGERY CENTER OF AIKEN | 830879278 | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $836.00 | 1558363549 - SUSQUEHANNA VALLEY SURGERY CENTER | 251847818 - (PA) SUSQUEHANNA VALLEY SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $990.00 | 1154034429 - CROSSINGS SURGERY CENTER, LLC | 881346867 - (RI) CROSSINGS SURGERY CENTER LLC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $171.00 | 1588777130 - J J YOUNG MD, THE CATARACT CENTER OF LAWTON | 731221077 - (OK) J J YOUNG MD | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $500.00 | 1790265999 - MUVE | 822351627 - (PA) MUVE | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $1150.00 | 1689059222 - GOLDSTEP AMBULATORY SURGERY CENTER, LLC | 465647464 - (NY) GOLDSTEP AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $725.00 | 1588092605 - GOLD COAST SURGERY CENTER, CENTER FOR SPECIALIZED SURGERY OF SANTA BARBARA | 460639888 - GOLD COAST SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $1061.00 | 1316470354 - MANHATTAN SPECIALISTS CENTER LLC | 813858597 - (KS) MANHATTAN SPECIALISTS CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $1364.00 | 1932530284 - VP SURGERY CENTER OF AUBURN LLC | 371668651 - (WA) VP SURGERY CENTER OF AUBURN LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $625.00 | 1669586376 - JEFFERSON AMBULATORY SURGERY CENTER LLC | 202349222 - (LA) JEFFERSON AMBULATORY SURGERY C | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43333 | $983.00 | 1821036138 - GAMMA SURGERY CENTER LLC | 270128900 - (PA) GAMMA SURGERY CENTER LLC | PA | 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 43333 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43333 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 43333 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 |
|---|---|---|
| 43333-CPT | High | Once Per Dos Repair, Paraesophageal Hiatal Hernia (Including Fundoplication), Via Laparotomy, Except Neonatal; With Implantation Of Mesh Or Other Prosthesis |
| 43334-CPT | High | Once Per Dos Repair, Paraesophageal Hiatal Hernia (Including Fundoplication), Via Thoracotomy, Except Neonatal; Without Implantation Of Mesh Or Other Prosthesis |
| 43335-CPT | High | Once Per Dos Repair, Paraesophageal Hiatal Hernia (Including Fundoplication), Via Thoracotomy, Except Neonatal; With Implantation Of Mesh Or Other Prosthesis |
| 43338-CPT | Low | Laparaoscopic Surgical Esophageal Lengthening Procedure (Eg Collis Gastroplasty Or Wedge Gastroplasty)(List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43333. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43333 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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