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See a sample rate comparisonCPT 43499 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.
Unlisted Procedure Esophagus, Unlisted Procedure Esophagus
| 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 | GC - Service performed by resident under supervision 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43499 |
| Medicaid Fee Schedule | $1,002.885 median of the 4 states in the free preview · View Medicaid rates for 43499 |
National average reimbursement for CPT 43499 by major payers:
$2,487.54
$228.00
$1,665.96
$1,164.70
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CPT 43499
5 of 25 sample ratesHigher to lower in this preview
Beltway Surgery Centers, LLC, Meridian South Surgery Center
$2,307.00Published rateJacksonville Endoscopy Centers LLC, Jacksonville Center For Endoscopy
$1,233.00Published ratePacific Northwest Urology Specialists, PLLC, Pacific Northwest Urology Surgery Center
Pacific Northwest Urology Specialist, PLLC
$896.00Published rateCenter For Advanced Reproductive Services, PC, Ambulatory Surgical Center At Reproductive Services
Center For Advanced Reproductive Services, P.C.
$640.00Published rateTreasure Coast Urology Center, LLC
Treasure Coast Urology Center LLC
$354.00Published rate
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See a sample payer proposalCPT 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.
| Code | Complexity | Description |
|---|---|---|
| 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 |
| 43501-CPT | High | Gastrotomy W Suture Repair |
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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