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See a sample rate comparisonCPT 43360 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.
Gastrointestinal Repair, Gastrointestinal Reconstruction For Previous Esophagectomy For Obstructing Esophageal Lesion Or Fistula Or For Previous Esophageal Exclusion With Stomach With Or Without Pyloroplasty
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 23 - Emergency Room |
| Common Modifiers | 78 - Return to OR - related procedure 62 - Co-Surgeons |
| Complexity Level | High |
| Medicare Fee Schedule | $2,121.63 national non-facility rate (2026) · View Medicare rates for 43360 |
| Medicaid Fee Schedule | $1,654.525 median of the 8 states in the free preview · View Medicaid rates for 43360 |
National average reimbursement for CPT 43360 by major payers:
$2,838.85
$3,064.01
$3,143.97
$3,588.87
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CPT 43360
5 of 25 sample ratesHigher to lower in this preview
Beltway Surgery Centers, LLC, Meridian South Surgery Center
$7,400.00Published rateDestin Surgery Center LLC
$1,064.00Published rateSurgery Center Of Decatur Lp
Surgery Center Of Decatur, Lp
$500.00Published rateFlorida Eye Institute Surgicenter LLC
$353.00Published rateMarin Ophthalmic Surgery Center
$132.00Published rate
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See a sample payer proposalCPT 43360 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43360 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 43360 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 |
|---|---|---|
| 43340-CPT | High | Esophagojejunostomy (W/O Total Gastrectomy); Abdomi Approa, Esophagojejunostomy (Without Total Gastrectomy); Abdominal Approach |
| 43341-CPT | High | Esophagojejunostomy (W/O Total Gastrectomy); Thoracic Approa, Esophagojejunostomy (Without Total Gastrectomy); Thoracic Approach |
| 43351-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 43360. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43360 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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