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See a sample rate comparisonCPT 43497 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | GC - Service performed by resident under supervision CG - Policy criteria applied |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $718.45 national non-facility rate (2026) · View Medicare rates for 43497 |
| Medicaid Fee Schedule | $580.585 median of the 8 states in the free preview · View Medicaid rates for 43497 |
National average reimbursement for CPT 43497 by major payers:
$962.93
$1,119.34
$1,110.45
$1,333.40
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CPT 43497
5 of 25 sample ratesHigher to lower in this preview
Trident Ambulatory Surgery Center, L.P.
Trident Ambulatory Surgery Center Lp
$6,455.00Published rateSapling Grove Ambulatory Surgery Center, LLC
Sapling Grove Ambulatory Surgery Center LLC
$1,954.00Published rateUniversity Of Miami, Umiami Medicine - Ophthalmology (Palm Beach Bascom Palmer - Asc)
University Of Miami
$1,355.00Published rateThe Surgical Center Of Greater Annapolis, Inc.
The Surgical Center Of Greater Annapolis Inc
$973.00Published rateOcala Endoscopy Asc Lp, Endoscopy Center Of Ocala
Ocala Endoscopy Asc Lp
$577.00Published rate
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See a sample payer proposalCPT 43497 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43497 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 43497 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 |
|---|---|---|
| 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. |
| 43499-CPT | High | Unlisted Procedure Esophagus, Unlisted Procedure Esophagus |
| 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 43497. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43497 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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