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See a sample rate comparisonCPT 43502 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.
Gastrotomy; W/ Suture Rpair Of Pre-Exist Esophagogastri Lacerat, Gastrotomy; With Suture Repair Of Pre-Existing Esophagogastric Lacerat
| 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 | 80 - Assistant surgeon AG - Primary physician 53 - Discontinued procedure 79 - Unrelated procedure - postop period GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | $1,423.21 national non-facility rate (2026) · View Medicare rates for 43502 |
| Medicaid Fee Schedule | $1,107.55 median of the 8 states in the free preview · View Medicaid rates for 43502 |
National average reimbursement for CPT 43502 by major payers:
$1,971.85
$2,025.21
$2,090.41
$2,467.36
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CPT 43502
5 of 25 sample ratesHigher to lower in this preview
Walnut Hill Surgery Center, LLC
Walnut Hill Surgery Center LLC
$6,068.00Published rateSurgcenter Of Greater Jacksonville, LLC
Surgcenter Of Greater Jacksonville LLC
$1,274.00Published rateSummit Ambulatory Surgical Center, LLC
$1,028.00Published ratePuget Sound Gastroenterology, PLLC, Evergreen Endoscopy Center
Puget Sound Gastroenterology, P.S.
$655.00Published rateGastroenterology Endoscopy Center
$300.00Published rate
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See a sample payer proposalCPT 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 | 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 |
| 43502-CPT | High | Gastrotomy; W/ Suture Rpair Of Pre-Exist Esophagogastri Lacerat, Gastrotomy; With Suture Repair Of Pre-Existing Esophagogastric Lacerat |
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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