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See a sample rate comparisonCPT 43450 Fee Schedule
Last Verified: October 2026
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.
Dilation Of Esophagus By Ung, Dilation Of Esophagus By Unguided Sound Or Bougie Single Or Multiple Passes Dilation Of Esophagus By Unguided Sound Or Bougie Single
| 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 | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $212.10 national non-facility rate (2026) · View Medicare rates for 43450 |
| Medicaid Fee Schedule | $166.065 median of the 8 states in the free preview · View Medicaid rates for 43450 |
National average reimbursement for CPT 43450 by major payers:
$207.09
$223.58
$252.01
$142.20
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CPT 43450
5 of 25 sample ratesHigher to lower in this preview
Performance Health Surgicenter, LLC
Performance Health Surgicenter LLC
$5,532.00Published rateLivingston Asc LLC
$2,064.00Published rateDcr Surgery Center, LLC
Dcr Surgery Center LLC
$725.00Published ratePhysicians Eye Surgery Center, Inc
Physicians Eye Surgery Center Inc
$587.00Published rateMeridian Surgery Center LLC
$341.00Published rate
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See a sample payer proposalCPT 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 Repair, 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 Anastomosis Es |
| 43420-CPT | High | Close Esophagostomy/Fistula Cerv |
| 43425-CPT | High | Closur Of Esophagostomy Or Fistula; Transthorc Or Transabdominal, Closure Of Esophagostomy Or Fistula; Transthoracic Or Transabdominal A |
| 43450-CPT | Moderate | Dilation Of Esophagus By Ung, Dilation Of Esophagus By Unguided Sound Or Bougie Single Or Multiple Passes Dilation Of Esophagus By Unguided Sound Or Bougie Single |
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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