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See a sample rate comparisonCPT 43520 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.
Pyloromyotom Cutting Of Pyloric Muscl(Fredet-Ramstedt Typ Opera, Pyloromyotomy Cutting Of Pyloric Muscle (Fredet-Ramstedt Type Operati
| 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 | GC - Service performed by resident under supervision AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $681.04 national non-facility rate (2026) · View Medicare rates for 43520 |
| Medicaid Fee Schedule | $532.42 median of the 8 states in the free preview · View Medicaid rates for 43520 |
National average reimbursement for CPT 43520 by major payers:
$851.42
$918.73
$967.25
$1,109.00
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CPT 43520
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Brazoria, LLC
Memorial Hermann Surgery Center Brazoria LLC
$4,893.00Published rateBluffton Okatie Surgery Center, L.L.C.
$1,167.00Published rateTaylor Station Surgical Center Ltd
Taylor Station Surgical Center
$973.00Published rateAdvanced Vision Surgery Center LLC
$555.00Published rateMount Dora Ophthalmology Asc LLC, Mid Florida Surgery Center
Mount Dora Ophthalmology Asc LLC
$163.00Published rate
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See a sample payer proposalCPT 43520 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43520 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 43520 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 |
|---|---|---|
| 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 |
| 43605-CPT | Moderate | Stomach Biopsy, Surgery To Remove A Sample Of Tissue For Testing (Biopsy) From The Stomach. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43520. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43520 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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