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See a sample rate comparisonCPT 43415 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.
Suture Of Esophageal Wound/Njury; Transthorc Or Transabdominal, Suture Of Esophageal Wound Or Injury; Transthoracic Or Transabdominal
| 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 | AS - PA/NP/CNS assistant at surgery GC - Service performed by resident under supervision 78 - Return to OR - related procedure 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | $2,414.55 national non-facility rate (2026) · View Medicare rates for 43415 |
| Medicaid Fee Schedule | $1,872.43 median of the 8 states in the free preview · View Medicaid rates for 43415 |
National average reimbursement for CPT 43415 by major payers:
$2,752.35
$3,148.35
$3,381.14
$3,848.39
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CPT 43415
5 of 25 sample ratesHigher to lower in this preview
Texas Health Spine Surgery Center Allen, LLC
Texas Health Spine Surgery Center Allen LLC
$6,068.00Published rateGreat South Bay Endoscopy Center, LLC
Great South Bay Endoscopy Center LLC
$1,192.00Published rateMichigan Surgical Center,LLC
Michigan Surgical Center
$780.00Published rateCherry Hill Women'S Center, Inc.
Cherry Hill Womens Center Inc
$483.00Published rateNisenfeld & Chilton, Md PA, Orthopaedic Associates Of Frederick, Asc
Nisenfeld & Chilton, M.D., P.A.
$50.00Published rate
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See a sample payer proposalCPT 43415 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43415 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 43415 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 |
|---|---|---|
| 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 |
| 43415-CPT | High | Suture Of Esophageal Wound/Njury; Transthorc Or Transabdominal, Suture Of Esophageal Wound Or Injury; Transthoracic Or Transabdominal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43415. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43415 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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