CPT 43400 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 • 51 - Multiple procedures • 82 - Assistant surgeon - no qualified resident • AG - Primary physician |
| Complexity Level | High |
| CMS | $1,484.38 Physician Fee Schedule |
National average reimbursement for CPT 43400 by major payers:
$1,860.15
$2,028.13
$2,093.24
$2,467.19
| 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 43400 | ||||||
United | 43400 | $7815.00 | 1801859970 - LOS GATOS SURGICAL CENTER, A CALIFORNIA LIMITED PARTNERSHIP | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $1150.00 | 1083228365 - REFOCUS SURGERY CENTERS, LLC | 851258648 | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $3500.00 | 1104819424 - VALLEY AMBULATORY SURGERY CENTER, LP, VALLEY AMBULATORY SURGERY CENTER | 363507061 - (IL) VALLEY AMBULATORY SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $6588.00 | 1376779561 - SURGICARE OF MIRAMAR LLC | 208552194 - (FL) SURGICARE OF MIRAMAR LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $2300.00 | 1346244845 - LAKELAND SURGICAL & DIAGNOSTIC CENTER LLP | 934728316 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $1077.00 | 1639215502 - BOSTON EYE SURGERY & LASER CENTER TRUST, BOSTON EYE SURGERY & LASER CENTER | 43092292 - (MA) BOSTON EYE SURGERY & LASER CENTER TRUST | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $5019.00 | 1710315619 - RIDGELINE SURGICENTER, LLC | 463848829 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $877.00 | 1215118930 - DELPHOS AMBULATORY SURGERY CENTER INC, DELPHOS ASC | 208412630 - (OH) DELPHOS AMBULATORY SURGERY CENTER INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $2100.00 | 1659377042 - TOMS RIVER AMBULATORY SURGICAL CENTER, BEY LEA AMBULATORY SURGICAL CENTER | 223802381 - (NJ) TOMS RIVER AMBULATORY SURGICAL CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $949.00 | 1902838402 - OUTPATIENT SURGERY CENTER, INC, MARINER SURGERY CENTER | 30504664 - (FL) OUTPATIENT SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $6500.00 | 1700400850 - FALCONHEAD SURGERY CENTER LLC | 844342209 - (TX) FALCONHEAD SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $4170.00 | 1013143007 - HARRISON ENDO SURGICAL CENTER LLC | 263234725 - (NJ) HARRISON ENDO SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $2394.00 | 1144650060 - SAN ANTONIO CHILDRENS SURGICAL | 464050149 - (TX) SAN ANTONIO CHILDRENS SURGICAL | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $2911.00 | 1427012202 - OUTPATIENT SURGICAL SERVICES LTD | 752433596 - (FL) OUTPATIENT SURGICAL SERVICES LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43400 | $3200.00 | 1982965612 - SKYPARK SURGERY CENTER LLC | 455320930 - (CA) SKYPARK SURGERY CENTER LLC | CA | 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 43400 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43400 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 43400 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 |
|---|---|---|
| 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 |
| 43400-CPT | High | Ligate Esophageal Varices Direct |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43400. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43400 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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