CPT 43499 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43499 |
National average reimbursement for CPT 43499 by major payers:
$2,487.54
$228.00
$1,665.96
$1,149.34
| 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 43499 | ||||||
United | 43499 | $1233.00 | 1366982845 - JACKSONVILLE ENDOSCOPY CENTERS LLC, JACKSONVILLE CENTER FOR ENDOSCOPY | 384016302 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $840.00 | 1386647402 - PHYSICIANS DAY SURGERY CENTER, LLC, PHYSICIANS DAY SURGERY CENTER, INC. | 593438026 - (FL) PHYSICIANS DAY SURGERY CENTER, INC. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $1022.00 | 1457968430 - PARK VENTURA ENDOSCOPY CENTER, LLC, DIGESTIVE HEALTH CENTER OF ALLEN | 412059014 - (TX) PARK VENTURA ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $600.00 | 1598339392 - COPPER CITY SURGERY CENTER, PLLC | 831039743 - (MT) COPPER CITY SURGERY CENTER PLLC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $640.00 | 1740442615 - CENTER FOR ADVANCED REPRODUCTIVE SERVICES, PC, AMBULATORY SURGICAL CENTER AT REPRODUCTIVE SERVICES | 61522659 - (CT) CENTER FOR ADVANCED REPRODUCTIVE SERVICES, P.C. | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $954.00 | 1336107580 - POMERADO OUTPATIENT SURGICAL CENTER L P, PALOMAR SURGICAL CENTER ESCONDIDO | 330752699 - (CA) POMERADO OUTPATIENT SURGICAL CENTER L P | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $1258.00 | 1275292229 - SCOTTSDALE ENDOSCOPY ASC LLC | 873952617 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $400.00 | 1346693124 - VILLAGES ENDOSCOPY CENTER LLC | 813250494 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $1319.00 | 1922230853 - CRYSTAL RUN AMBULATORY SURGERY CENTER OF MIDDLETOWN, LLC | 270476822 - (NY) CRYSTAL RUN AMBULATORY SURGERY CENTER OF MIDDLETOWN, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $1233.00 | 1801146535 - SURGCENTER AT PARADISE VALLEY, LLC, SURGCENTER AT PIMA CROSSING | 455364868 - (AZ) SURGCENTER AT PARADISE VALLEY | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $713.00 | 1801343496 - TRADITION SURGERY CENTER, LLC | 364837780 - (FL) TRADITION SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $725.00 | 1114552338 - GEORGIA INTERVENTIONAL PAIN | 842028147 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $354.00 | 1316253438 - TREASURE COAST UROLOGY CENTER, LLC | 273328667 - (FL) TREASURE COAST UROLOGY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $461.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43499 | $994.00 | 1437597812 - VIVERE HEALTH AUSTIN, LLC, VIVERE AUSTIN SURGERY CENTER | 611694454 - (TX) VIVERE HEALTH AUSTIN LLC | TX | 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 43499 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43499 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 43499 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43499 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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