CPT 43610 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43610 |
National average reimbursement for CPT 43610 by major payers:
$1,210.09
$1,301.91
$1,389.86
$1,590.50
| 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 43610 | ||||||
United | 43610 | $750.00 | 1285108845 - MARIETTA ADVANCED SURGERY CENTER | 832382468 - (GA) MARIETTA ADVANCED SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $494.00 | 1073556338 - VALDOSTA PODIATRY ASSOCIATES, PC, NORTH OAK AMBULATORY SURGERY CENTER | 261479859 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $235.00 | 1639176183 - BERKS CENTER FOR DIGESTIVE HEALTH, LP | 233068912 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $2705.00 | 1619218096 - SAN MARCOS ASC LLC | 800899088 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $433.00 | 1417904756 - METROPOLITAN MEDICAL CENTER, LLC | 202804280 - (WI) METROPOLITAN MEDICAL CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $2732.00 | 1629458427 - CLARKSVILLE SURGICENTER, LLC | 473830244 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $122.00 | 1386794980 - NEW VISION CATARACT CENTER LLC, NEW VISION CATARACT CENTER | 61557487 - (CT) NEW VISION CATARACT CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $564.00 | 1588323513 - RIVER POINT SURGERY CENTER, LLC | 863521069 - RIVER POINT SURGERY CENTER | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $711.00 | 1053508077 - JOURNEY LITE OF CINCINNATI, LLC | 208861350 - (OH) JOURNEYLITE OF CINCINNATI, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $326.00 | 1942242441 - ADVANCED EYE SURGERY CENTER, LLC | 510567447 - (FL) ADVANCED EYE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $479.00 | 1073888103 - SURGERY BY VOLD VISION | 454504788 - (AR) SURGERY BY VOLD VISION | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $1049.00 | 1215492061 - ADVANCED SPINE CENTER OF WISCONSIN, LLC | 832438541 - (WI) ADVANCED SPINE CENTER OF WISCONSIN | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $1306.00 | 1043297872 - CENTRAL JERSEY AMBULATORY SURGICAL CENTER, LLC | 223669777 - (NJ) CENTRAL JERSEY AMBULATORY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $443.00 | 1043565542 - MAGNOLIA SURGERY CENTER, LLC | 364702180 - (AR) MAGNOLIA SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43610 | $1049.00 | 1053714758 - TEXAS PRECISION SURGERY CENTER | 471332895 - (TX) TEXAS PRECISION SURGERY CENTER L | TX | 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 43610 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43610 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 43610 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43610. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43610 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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