CPT 43450 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $181.14 Physician Fee Schedule |
National average reimbursement for CPT 43450 by major payers:
$207.09
$223.58
$252.01
$291.70
| 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 43450 | ||||||
United | 43450 | $1200.00 | 1245207687 - CDI TWIN CITIES ASC LLC, RAYUS TWIN CITIES ASC | 820565885 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $2344.00 | 1821528753 - KENNEDY CHERRY HILL SURGICAL CENTER LLC, JEFFERSON SURGERY CENTER - CHERRY HILL | 472462625 - (NJ) KENNEDY CHERRY HILL SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $580.00 | 1376556514 - EYE CARE SPECIALISTS PS, THE LASER AND SURGERY CENTER | 911895676 - (WA) EYECARE SPECIALIST, PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $670.00 | 1497949705 - IDAHO PHYSICAL MEDICINE AND REHABILITATION PA | 820435241 - (ID) IDAHO PHYSICAL MEDICINE & REHABILITATION, PA | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $580.00 | 1831551266 - INOV8 SURGICAL AT MEMORIAL CITY, INOV8 SURGICAL | 475640889 - (TX) INOV8 SURGICAL AT MEMORIAL CITY | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $544.00 | 1750312435 - CENTRAL ARIZONA ENDOSCOPY LLC | 203643513 - (AZ) CENTRAL ARIZONA ENDOSCOPY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $633.00 | 1558497263 - ARTHUR N DONALDSON M D INC, SONORA EYE SURGERY CENTER | 942593611 - ARTHUR N DONALDSON MD INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $753.50 | 1316949415 - NEWPORT BEACH SURGERY CENTER, LLC, NEWPORT BEACH SURGERY CENTER | 330488134 - (CA) NEWPORT BEACH SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $753.50 | 1538403670 - FRESNO CA MULTI ASC LP, HERNDON SURGERY CENTER | 461297783 - (CA) FRESNO CA MULTI ASC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $902.00 | 1316936016 - WESTLAKE SPINE & OUTPATIENT SURGERY CENTER | 204997865 - (CA) JOURNEY LITE OF THE CENTRAL COAST LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $753.50 | 1477527398 - TEMECULA CA ENDOSCOPY ASC LP, TEMECULA VALLEY ENDOSCOPY CENTER | 200095307 - (CA) TEMECULA CA ENDOSCOPY ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $2629.00 | 1801974720 - SUMMIT SURGICAL CENTER, LLC | 731730859 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $1981.00 | 1811101439 - SENTARA OBICI AMBULATORY SURGERY, LLC | 260144898 - (VA) SENTARA OBICI AMBULATORY SURGERY, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $550.00 | 1811052749 - GDC ENDOSCOPY CENTER LLC | 651240653 - (GA) GDC ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43450 | $4147.00 | 1497244149 - HOSPITAL FOR SPECIAL SURGERY WEST SIDE AMBULATORY SURGERY CENTER, LLC, HSS WEST SIDE ASC, LLC | 814351390 | NY | 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 43450 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43450 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 43450 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 |
| 43420-CPT | High | Close Esophagostomy/Fistula Cerv |
| 43425-CPT | High | Close Esophagostomy/Fistula Thorac |
| 43450-CPT | Moderate | Dilate Esophagus Indirect Initial |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43450. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43450 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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