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See a sample rate comparisonCPT 43496 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.
Intestine Tissue For Repair, Surgery That Uses Intestinal Tissue To Repair And Reconstruct Portions Of The Digestive System After Surgery For Cancer.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | 62 - Co-Surgeons 52 - Reduced Services 82 - Assistant surgeon - no qualified resident 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43496 |
| Medicaid Fee Schedule | $1,158.81 median of the 8 states in the free preview · View Medicaid rates for 43496 |
National average reimbursement for CPT 43496 by major payers:
$1,967.58
$2,776.68
$2,787.66
$4,041.10
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CPT 43496
5 of 25 sample ratesHigher to lower in this preview
Nmc Surgery Center, L.P., The Surgery Center Of Nacogdoches
Nmc Surgery Center Lp
$9,043.00Published rateOrthopaedic Surgery Center Of Illinois, LLC
Orthopaedic Surgery Center Of Illinois LLC
$1,095.00Published ratePalouse Surgery Center, LLC
Palouse Surgery Center LLC
$825.00Published rateEndoscopy Center Of Dayton North LLC
$454.00Published rateThe Glendale Az Endoscopy Asc LLC, Thunderbird Endoscopy Center
$109.00Published rate
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See a sample payer proposalCPT 43496 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43496 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 43496 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. |
| 43497-CPT | Moderate | Surgery To Improve Esophagus, Procedure To Treat A Disorder Of The Esophagus And Allow A Better Passage Of Food And Liquids From The Esophagus Into The Stomach. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43496. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43496 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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