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See a sample rate comparisonCPT 43500 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.
Gastrotomy W Explore/Rem Fb
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $751.85 national non-facility rate (2026) · View Medicare rates for 43500 |
| Medicaid Fee Schedule | $583.79 median of the 8 states in the free preview · View Medicaid rates for 43500 |
National average reimbursement for CPT 43500 by major payers:
$927.15
$1,037.64
$1,094.92
$1,248.28
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CPT 43500
5 of 25 sample ratesHigher to lower in this preview
Bailey Square Ambulatory Surgical Center, Ltd
Bailey Square Ambulatory Surgical Center Ltd
$2,575.00Published rateNorth Shore Same Day Surgery LLC, North Shore Surgical Center
North Shore Same Day Surgery LLC
$1,064.00Published ratePlymouth Orthopedic Surgery Center LLC, Plymouth Orthopedic Surgery Center
Plymouth Orthopedic Surgery Center LLC
$812.00Published rateFairfax Colon & Rectal Surgery Center, LLC
$438.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$63.00Published rate
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See a sample payer proposalCPT 43500 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43500 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 43500 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 |
|---|---|---|
| 43450-CPT | Moderate | Dilation Of Esophagus By Ung, Dilation Of Esophagus By Unguided Sound Or Bougie Single Or Multiple Passes Dilation Of Esophagus By Unguided Sound Or Bougie Single |
| 43453-CPT | Moderate | Dilate Esophagus W Guide |
| 43460-CPT | Moderate | Esophagogastric Tamponade W Balloon Seng |
| 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 43500. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43500 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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