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See a sample rate comparisonCPT 43333 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.
Repair Of A Stomach Hernia, Surgery To Repair A Stomach Hernia. The Protruding Stomach Is Moved Back Into Place And The Opening In The Diaphragm Is Stitched Smaller. Mesh May Be Implanted To Hold The Tissue In Place.
| 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 | AS - PA/NP/CNS assistant at surgery 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | $1,175.71 national non-facility rate (2026) · View Medicare rates for 43333 |
| Medicaid Fee Schedule | $910.845 median of the 8 states in the free preview · View Medicaid rates for 43333 |
National average reimbursement for CPT 43333 by major payers:
$1,666.60
$1,775.98
$1,758.09
$2,073.98
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CPT 43333
5 of 25 sample ratesHigher to lower in this preview
Bayside Ambulatory Center, LLC
$2,732.00Published rateManhattan Specialists Center LLC
$1,061.00Published rateEhi Surgery Center Austin, LLC, Legent Outpatient Surgery - Austin
Ehi Surgery Center Austin LLC
$850.00Published rateMuve
$500.00Published rateJ J Young Md, The Cataract Center Of Lawton
J J Young Md
$171.00Published rate
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See a sample payer proposalCPT 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 | Repair Of A Stomach Hernia, Surgery To Repair A Stomach Hernia. The Protruding Stomach Is Moved Back Into Place And The Opening In The Diaphragm Is Stitched Smaller. Mesh May Be Implanted To Hold The Tissue In Place. |
| 43334-CPT | High | Repair Of A Stomach Hernia, Surgery To Repair A Stomach Hernia. The Protruding Stomach Is Moved Back Into Place And The Opening In The Diaphragm Is Stitched Smaller. Mesh May Be Implanted To Hold The Tissue In Place. |
| 43335-CPT | High | Repair Of A Stomach Hernia, Surgery To Repair A Stomach Hernia. The Protruding Stomach Is Moved Back Into Place And The Opening In The Diaphragm Is Stitched Smaller. Mesh May Be Implanted To Hold The Tissue In Place. |
| 43338-CPT | Low | Esophageal Lengthening Procedu, Esophageal Lengthening Procedure (Eg Collis Gastroplasty Or Wedge Gastroplasty) (List Separately Inaddition 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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