CPT 43351 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 • 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 | View Medicare rates for 43351 |
National average reimbursement for CPT 43351 by major payers:
$1,638.51
$1,764.14
$1,812.42
$2,140.88
| 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 43351 | ||||||
United | 43351 | $1647.00 | 1447768411 - WISCONSIN INSTITUTE OF SURGICAL EXCELLENCE LLC | 821710492 - (WI) WISCONSIN INSTITUTE OF SURGICAL EXCELLENCE LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $1775.00 | 1861766016 - HAYS SURGERY CENTER, LLC | 274579547 - (TX) HAYS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $1955.00 | 1245798826 - SURGCENTER OF GREATER DALLAS, LLC., SURGCENTER OF GREATER DALLAS | 831498677 - (TX) SURGCENTER OF GREATER DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $1100.00 | 1811125149 - KNOXVILLE ORTHOPAEDIC SURGERY CENTER LLC | 262437385 - (TN) KNOXVILLE ORTHOPAEDIC SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $1682.00 | 1598258865 - NORTHERN WESTCHESTER FACILITY PROJECT LLC, YORKTOWN CENTER FOR SPECIALTY SURGERY | 383989643 - (NY) NORTHERN WESTCHESTER FACILITY PROJECT LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $983.00 | 1245263292 - CHATTANOOGA PAIN MANAGEMENT CENTER LLC, CHATTANOOGA PAIN SURGERY CENTER | 320121593 - (TN) CHATTANOOGA PAIN MANAGEMENT | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $1028.00 | 1487620043 - NEW HORIZONS SURGERY CENTER LLC | 731572167 - (OH) NEW HORIZONS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $544.00 | 1629145685 - IDAHO EYE CENTER PA, IDAHO EYE SURGICENTER | 820379995 - (ID) IDAHO EYE CENTER, P.A. | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $328.00 | 1063996734 - COASTAL ENDO, LLC, COASTAL ENDOSCOPY CENTER | 831370400 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $750.00 | 1831200120 - FAMILY SURGERY CENTER, LLC | 202053325 - (MN) FAMILY SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $1306.00 | 1043297872 - CENTRAL JERSEY AMBULATORY SURGICAL CENTER, LLC | 223669777 - (NJ) CENTRAL JERSEY AMBULATORY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $1343.00 | 1437574191 - OIL CENTER SURGICAL PLAZA | 464090110 - (LA) OIL CENTER SURGICAL PLAZA | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $1064.00 | 1750823886 - LAKE ENDOSCOPY CENTER, LLC | 814225104 - (FL) LAKE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $5554.00 | 1366776106 - MEMORIAL HERMANN SURGERY CENTER RICHMOND, LLC, MEMORIAL HERMANN SURGERY CENTER RICHMOND | 270552583 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43351 | $122.00 | 1225140510 - NORTHEAST AMBULATORY CENTER INC | 43382778 - (MA) NORTHEAST AMBULATORY CENTER, INC. | MA | 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 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 | Once Per Dos Repair, Paraesophageal Hiatal Hernia (Including Fundoplication), Via Thoracoabdominal Incision, Except Neonatal; With Implantation Of Mesh Or Other Prosthesis |
| 43351-CPT | High | Esophagostomy Ext Thoracic |
| 43352-CPT | High | Esophagostomy, External; Cervical Approa |
| 43360-CPT | High | 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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