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See a sample rate comparisonCPT 43351 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.
Surgery For Esophagus Opening, Surgery To Create An Artificial Opening (Fistula) Into The Esophagus From The Outside Of The Body.
| 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 | 78 - Return to OR - related procedure 22 - Increased Procedural Services 58 - Staged or related procedure during postoperative period 62 - Co-Surgeons |
| Complexity Level | High |
| Medicare Fee Schedule | $1,275.58 national non-facility rate (2026) · View Medicare rates for 43351 |
| Medicaid Fee Schedule | $999.485 median of the 8 states in the free preview · View Medicaid rates for 43351 |
National average reimbursement for CPT 43351 by major payers:
$1,638.51
$1,764.14
$1,812.42
$2,095.51
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CPT 43351
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Richmond, LLC, Memorial Hermann Surgery Center Richmond
$5,554.00Published rateDoctors Outpatient Center For Surgery, LLC
Doctors Outpatient Center For Surgery LLC
$1,322.00Published rateSafety Harbor Asc Company LLC, Safety Harbor Surgery Center
$1,049.00Published ratePacific Cataract And Laser Institute Inc PC
Pacific Cataract And Laser Institute, Inc., PC
$624.00Published rateNortheast Ambulatory Center Inc
Northeast Ambulatory Center, Inc.
$122.00Published rate
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See a sample payer proposalCPT 43351 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43351 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 43351 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 |
|---|---|---|
| 43337-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. |
| 43351-CPT | High | Surgery For Esophagus Opening, Surgery To Create An Artificial Opening (Fistula) Into The Esophagus From The Outside Of The Body. |
| 43352-CPT | High | Surgery For Esophagus Opening, Surgery To Create An Artificial Opening (Fistula) Into The Esophagus From The Outside Of The Body. |
| 43360-CPT | High | Gastrointestinal Repair, Gastrointestinal Reconstruction For Previous Esophagectomy For Obstructing Esophageal Lesion Or Fistula Or For Previous Esophageal Exclusion With Stomach With Or Without Pyloroplasty |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43351. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43351 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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