CPT 43502 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 | • 21 - Inpatient Hospital • 20 - Urgent Care Facility |
| Common Modifiers | • None • 80 - Assistant surgeon • AG - Primary physician • 53 - Discontinued procedure • 79 - Unrelated procedure - postop period • GC - Service performed by resident under supervision |
| Complexity Level | High |
| CMS | $1,487.94 Physician Fee Schedule |
National average reimbursement for CPT 43502 by major payers:
$1,971.85
$2,025.21
$2,090.41
$2,467.36
| 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 43502 | ||||||
United | 43502 | $766.00 | 1508986621 - ASHLAND SURGERY CENTER | 830346584 - (OR) ASHLAND SURGERY CENTER INC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $525.00 | 1457354300 - SURGERY CENTER OF OCALA LLC | 621808594 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $1274.00 | 1013964063 - BRISTOL SURGERY CENTER, LLC | 834345983 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $1124.00 | 1154088490 - BSC 3 LLC, BANNER SURGERY CENTER - SPORTS MEDICINE | 871712552 - (AZ) BSC 3 LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $840.00 | 1548842180 - DIGESTIVE HEALTH CENTER LLC | 853810510 - (IA) DIGESTIVE HEALTH CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $1274.00 | 1477569069 - FISH POND SURGERY CENTER, LLC | 742901471 - (TX) FISH POND SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $200.00 | 1063819860 - TYLER ASC, LP, TYLER CARDIAC & ENDOVASCULAR SURGERY CENTER | 471418553 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $2705.00 | 1043874621 - BROWNSVILLE SURGICENTER, LLC | 825464594 - (TX) BROWNSVILLE SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $6068.00 | 1619093218 - CLEBURNE SURGICAL CENTER, LLC | 203742012 - (TX) CLEBURNE SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $1064.00 | 1114302353 - POINT OF ROCKS SURGERY CENTER, LLC | 464992977 - (MD) POINT OF ROCKS SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $300.00 | 1316976137 - CENTRAL MARYLAND ENDOSCOPY LLC | 201580201 - (MD) CENTRAL MARYLAND ENDOSCOPY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $1456.00 | 1023218500 - SAN MARTIN SURGERY CENTER LLC | 202999408 - (NV) SAN MARTIN SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $600.00 | 1639290026 - JOHNS HOPKINS SURGERY CENTERS SERIES | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $384.00 | 1720752629 - BAY SURGERY CENTERS | 453365193 - (MD) BAY SURGERY CENTERS | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43502 | $421.00 | 1639183486 - SAN JOAQUIN LASER SURGERY CENTER | 943308994 - (CA) SAN JOAQUIN LASER SURGERY CENTER | CA | 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 43502 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43502 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 43502 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 |
|---|---|---|
| 43460-CPT | Moderate | Esophagogastric Tamponade W Balloon Seng |
| 43497-CPT | Moderate | Lower Esophageal Myotomy, Transoral (I.E., Peroral Endoscopic Myotomy (Poem)) |
| 43499-CPT | High | Unlisted Procedure, Esophagus Stomach |
| 43502-CPT | High | Gastrotomy; W/Suture Repair Of Pre-Existing Esophagogastric Laceration |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43502. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43502 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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