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See a sample rate comparisonCPT 43510 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.
Surgery To Enlarge Esophagus, Surgery To Increase The Inside Diameter Of The Esophagus. A Tube Is Inserted Through The Stomach To Permanently Enlarge The Esophagus.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 23 - Emergency Room |
| Common Modifiers | AG - Primary physician XU - Unusual Non-Overlapping Service AA - Anesthesia by anesthesiologist 82 - Assistant surgeon - no qualified resident AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | $903.83 national non-facility rate (2026) · View Medicare rates for 43510 |
| Medicaid Fee Schedule | $701.425 median of the 8 states in the free preview · View Medicaid rates for 43510 |
National average reimbursement for CPT 43510 by major payers:
$1,193.61
$1,257.47
$1,299.44
$1,542.68
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CPT 43510
5 of 25 sample ratesHigher to lower in this preview
Temple University Hospital, Inc
Temple University Hospital Inc
$6,189.00Published rateSurgcenter Camelback LLC
$1,276.00Published rateSt. Louis Women'S Surgery Center, LLC, St. Louis Multispecialty Surgery Center
St Louis Womens Surgery Center LLC
$891.00Published rateUch Vascular Access Asc LLC
$559.00Published rateJohn P Lydon Dpm, Bethesda Ambulatory Surgical Center
John P Lydon, Dpm
$197.00Published rate
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See a sample payer proposalCPT 43510 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43510 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 43510 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 |
|---|---|---|
| 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 |
| 43510-CPT | High | Surgery To Enlarge Esophagus, Surgery To Increase The Inside Diameter Of The Esophagus. A Tube Is Inserted Through The Stomach To Permanently Enlarge The Esophagus. |
| 43520-CPT | Moderate | Pyloromyotom Cutting Of Pyloric Muscl(Fredet-Ramstedt Typ Opera, Pyloromyotomy Cutting Of Pyloric Muscle (Fredet-Ramstedt Type Operati |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43510. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43510 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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