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See a sample rate comparisonCPT 43405 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.
Ligati Or Stapl At Gastroesophageal Jnction For Pre-Exist Eso, Ligation Or Stapling At Gastroesophageal Junction For Pre-Existing Eso
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 99 - Other POS 24 - Ambulatory Surgical Center |
| Common Modifiers | 78 - Return to OR - related procedure 80 - Assistant surgeon 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | $1,402.17 national non-facility rate (2026) · View Medicare rates for 43405 |
| Medicaid Fee Schedule | $1,089.475 median of the 8 states in the free preview · View Medicaid rates for 43405 |
National average reimbursement for CPT 43405 by major payers:
$1,718.58
$1,944.53
$2,015.98
$2,276.26
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CPT 43405
5 of 25 sample ratesHigher to lower in this preview
Mclean Ambulatory Surgery, LLC
Mclean Ambulatory Surgery LLC
$4,165.00Published rateThe Surgery Center At Sacred Heart Medical Park, Destin, LLC
The Surgery Center At Sacred Heart Medical Park Destin LLC
$935.00Published rateThe Orthopaedic And Spine Center Of Southern Colorado, LLC
The Orthopaedic & Spine Center Of S Colorado
$625.00Published rateVivere Health New Orleans, LLC, Vivere Audubon Surgery Center
Vivere Health New Orleans LLC
$523.00Published rateMacon Outpatient Surgery Inc
$300.00Published rate
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See a sample payer proposalCPT 43405 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43405 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 43405 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 | Surgery For Esophagus Opening, Surgery To Create An Artificial Opening (Fistula) Into The Esophagus From The Outside Of The Body. |
| 43400-CPT | High | Ligate Esophageal Varices Direct |
| 43405-CPT | High | Ligati Or Stapl At Gastroesophageal Jnction For Pre-Exist Eso, Ligation Or Stapling At Gastroesophageal Junction For Pre-Existing Eso |
| 43410-CPT | High | Suture Esophagus Cervical |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43405 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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