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See a sample rate comparisonCPT 43605 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.
Stomach Biopsy, Surgery To Remove A Sample Of Tissue For Testing (Biopsy) From The Stomach.
| 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 | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $800.62 national non-facility rate (2026) · View Medicare rates for 43605 |
| Medicaid Fee Schedule | $624.205 median of the 8 states in the free preview · View Medicaid rates for 43605 |
National average reimbursement for CPT 43605 by major payers:
$996.69
$1,108.24
$1,151.29
$1,328.46
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CPT 43605
5 of 25 sample ratesHigher to lower in this preview
Denton Surgicare Partners Ltd, Baylor Scott & White Surgicare - Denton
Denton Surgicare Partners Ltd
$3,150.00Published rateCenter For Urologic Surgery LLC
$1,667.00Published rateInterventional Pain Management LLC
$1,457.00Published rateRegional Urology Asc LLC
$982.00Published rateOcala Endoscopy Asc Lp, Endoscopy Center Of Ocala
Ocala Endoscopy Asc Lp
$577.00Published rate
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See a sample payer proposalCPT 43605 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43605 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 43605 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 |
|---|---|---|
| 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. |
| 43610-CPT | High | Excision Local Stomach Ulceror Tumor |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43605. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43605 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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