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See a sample rate comparisonCPT 43460 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.
Esophagogastric Tamponade W Balloon Seng
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 23 - Emergency Room 22 - On Campus Outpatient Hospital |
| Common Modifiers | AG - Primary physician GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $187.71 national non-facility rate (2026) · View Medicare rates for 43460 |
| Medicaid Fee Schedule | $152.715 median of the 8 states in the free preview · View Medicaid rates for 43460 |
National average reimbursement for CPT 43460 by major payers:
$278.58
$290.30
$297.91
$349.83
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CPT 43460
5 of 25 sample ratesHigher to lower in this preview
St. Francis Mooresville Surgery Center, LLC
$6,489.00Published rateTri-City Regional Surgery Center LLC
Tri-City Regional Surgery Center
$1,500.00Published rateGenesys Surgery Center LLC
$907.00Published rateWaterford Surgical Center, LLC
Waterford Surgical Center
$524.00Published rateProgressive Surgical Institute Inc.
Progressive Surgical Institute Inc
$200.00Published rate
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See a sample payer proposalCPT 43460 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43460 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 43460 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 |
|---|---|---|
| 43453-CPT | Moderate | Dilate Esophagus W Guide |
| 43460-CPT | Moderate | Esophagogastric Tamponade W Balloon Seng |
| 43496-CPT | High | Intestine Tissue For Repair, Surgery That Uses Intestinal Tissue To Repair And Reconstruct Portions Of The Digestive System After Surgery For Cancer. |
| 43500-CPT | Moderate | Gastrotomy W Explore/Rem Fb |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43460. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43460 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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