CPT 43420 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 • 62 - Co-Surgeons • 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43420 |
National average reimbursement for CPT 43420 by major payers:
$1,252.42
$1,343.15
$1,400.58
$1,679.01
| 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 43420 | ||||||
United | 43420 | $2500.00 | 1184749673 - WAYNE SURGICAL CENTER LLC | 223535325 - (NJ) WAYNE SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $1505.00 | 1770076010 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC ASC SAFFORD | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $620.00 | 1902838402 - OUTPATIENT SURGERY CENTER, INC, MARINER SURGERY CENTER | 30504664 - (FL) OUTPATIENT SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $1284.00 | 1760598577 - ACUTE & CHRONIC PAIN MANAGEMENT CENTER PA, ACUTE & CHRONIC PAIN AND SPINE CENTER | 752711926 - (TX) ACUTE AND CHRONIC PAIN AND SPINE CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $1477.00 | 1669021283 - EL DORADO SURGERY CENTER LP, TUCSON ENDOSCOPY CENTER | 850474225 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $2093.00 | 1063715951 - NEW BRITAIN SURGERY CENTER LLC | 273829147 - (PA) NEW BRITAIN SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $2263.00 | 1477242154 - PLYMOUTH ORTHOPEDIC SURGERY CENTER LLC, PLYMOUTH ORTHOPEDIC SURGERY CENTER | 883632673 - (MN) PLYMOUTH ORTHOPEDIC SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $1590.00 | 1487628301 - SAN ANTONIO TX ENDOSCOPY ASC LP, SAN ANTONIO GASTROENTEROLOGY ENDOSCOPY CENTER | 200075829 - (TX) SAN ANTONIO TX ENDOSCOPY ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $1339.00 | 1841342789 - SURGERY CENTER JV, THE SURGERY CENTER OF HUNTSVILLE | 621230866 - (AL) THE SURGERY CENTER OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $6651.00 | 1376507194 - COLUMBIA EYE AND SPECIALTY SURGERY CENTER LTD | 752528760 - (FL) COLUMBIA EYE AND SPECIALTY SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $862.00 | 1295772101 - CAPE CORAL AMBULATORY SURGERY CENTER, LLC, CAPE CORAL SURGERY CENTER | 202001489 - (FL) CAPE CORAL AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $2388.00 | 1114302353 - POINT OF ROCKS SURGERY CENTER, LLC | 464992977 - (MD) POINT OF ROCKS SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $2119.00 | 1093433021 - SYNERGY SURGICENTER, LLC, SYNERGY SURGERY CENTER | 872796682 - SYNERGY SURGICENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $1600.00 | 1700424322 - GEORGIA INTERVENTIONAL PAIN | 841727755 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43420 | $2900.00 | 1538164546 - SURGERY CENTER AT PELHAM, LLC | 760745215 - (SC) SURGERY CENTER AT PELHAM, LLC | SC | 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 43420 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43420 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 43420 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 |
|---|---|---|
| 43361-CPT | High | 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 Anastomosi |
| 43410-CPT | High | Suture Esophagus Cervical |
| 43415-CPT | High | Suture Esophagus Thoracic |
| 43420-CPT | High | Close Esophagostomy/Fistula Cerv |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43420 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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