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See a sample rate comparisonCPT 43361 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 Colon Interposition Or Small Intestine Reconstruction Including Intestine Mobilization Preparation And Anastomosis Es
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | 62 - Co-Surgeons 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| Medicare Fee Schedule | $2,507.74 national non-facility rate (2026) · View Medicare rates for 43361 |
| Medicaid Fee Schedule | $1,950.00 median of the 8 states in the free preview · View Medicaid rates for 43361 |
National average reimbursement for CPT 43361 by major payers:
$3,408.72
$3,563.57
$3,740.08
$4,247.51
Compare published rates across providers.
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CPT 43361
5 of 25 sample ratesHigher to lower in this preview
Lincoln Surgery Center LLC
Lincoln Surgery Center, LLC
$2,785.00Published rateChicago Prostate Cancer Surgery Center, LLC, Dupage Medical Group Surgery Center, Westmont
Chicago Prostate Cancer Surgery Center LLC
$1,137.00Published rateBanner Surgery Center
$1,000.00Published rateParkside Surgery Center, LLC
Parkside Surgery Center
$475.00Published rateLittle Rock Surgery Center, LLC
Little Rock Surgery Center
$307.00Published rate
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See a sample payer proposalCPT 43361 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43361 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 43361 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 |
|---|---|---|
| 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 |
| 43361-CPT | High | Gastrointestinal Repair, Gastrointestinal Reconstruction For Previous Esophagectomy For Obstructing Esophageal Lesion Or Fistula Or For Previous Esophageal Exclusion With Colon Interposition Or Small Intestine Reconstruction Including Intestine Mobilization Preparation And Anastomosis Es |
| 43420-CPT | High | Close Esophagostomy/Fistula Cerv |
| 43425-CPT | High | Closur Of Esophagostomy Or Fistula; Transthorc Or Transabdominal, Closure Of Esophagostomy Or Fistula; Transthoracic Or Transabdominal A |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43361. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43361 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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