CPT 43338 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • GC - Service performed by resident under supervision • 62 - Co-Surgeons • 80 - Assistant surgeon |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 43338 |
National average reimbursement for CPT 43338 by major payers:
$158.07
$170.81
$162.26
$205.82
| 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 43338 | ||||||
United | 43338 | $1344.00 | 1962568543 - ENDOSCOPY CENTER OF OCEAN COUNTY, LLC | 223461117 - (NJ) ENDOSCOPY CENTER OF OCEAN COUNTY, PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $1612.50 | 1811220429 - SURGICARE OF MANHATTAN, LLC | 205679305 - (NY) SURGICARE OF MANHATTAN LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $1028.00 | 1134613979 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $2732.00 | 1720566433 - PAVILION SURGICENTER, LLC, PHYSICIANS PAVILION SURGERY CENTER | 830619935 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $1937.00 | 1720023484 - SPALDING TRIANGLE SURGERY CENTER, LLC, SPALDING TRIANGLE SURGERY CENTER | 760769099 - (CA) SPALDING TRIANGLE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $1049.00 | 1871032680 - OLIVE AMBULATORY SURGERY CENTER, LLC, NORTH CAMPUS SURGERY CENTER | 203834012 - (MO) OLIVE AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $1075.00 | 1508040486 - PORTLAND CLINIC, ROGER E. ALBERTY, M.D. SURGICAL CENTER | 930400952 - (OR) THE PORTLAND CLINIC LLP | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $439.00 | 1760196984 - JACKSON HEART AND VASCULAR CENTER LLC | 870947298 - (MS) JACKSON HEART AND VASCULAR CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $2737.00 | 1881662856 - SILICON VALLEY SURGERY CENTER, LP | 770495522 - (CA) SILICON VALLEY SURGERY CENTER, L.P. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $973.00 | 1902895675 - CAROMONT HEALTH SERVICES, INC., CAROMONT SPECIALTY SURGERY | 561455630 - (NC) CAROMONT HEALTH SERVICES INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $544.00 | 1467016055 - HARBIN CLINIC, LLC, HARBIN CLINIC GI LAB CARTERSVILLE | 582234927 - (GA) THE HARBIN CLINIC, L.L.C. | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $512.00 | 1134687981 - ARMENIA AMBULATORY SURGICAL CENTER, LLC | 833888664 - (FL) ARMENIA AMBULATORY SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $6068.00 | 1982716106 - THR/STT SOUTHLAKE ASC, LLC | 262429878 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $658.00 | 1629135843 - NAEEM M AKHTAR, MADERA AMBULATORY ENDOSCOPY CENTER | 770194609 - (CA) NAEEM M. AKHTAR, M.D. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43338 | $653.00 | 1215204128 - MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE, P.C., ALLSPINE SURGERY CENTER, P.C. | 274395849 - (GA) MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE PC | GA | 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 43338 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43338 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 43338 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 43338. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43338 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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