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See a sample rate comparisonCPT 43620 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.
Remove Stomach Join To Bowel, Surgery To Remove The Stomach. The Procedure Includes The Formation Of A New Connection Between The Esophagus And The Intestine.
| 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 | 22 - Increased Procedural Services 52 - Reduced Services |
| Complexity Level | High |
| Medicare Fee Schedule | $1,834.38 national non-facility rate (2026) · View Medicare rates for 43620 |
| Medicaid Fee Schedule | $1,424.975 median of the 8 states in the free preview · View Medicaid rates for 43620 |
National average reimbursement for CPT 43620 by major payers:
$2,463.89
$2,629.66
$2,732.06
$3,123.91
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CPT 43620
5 of 25 sample ratesHigher to lower in this preview
North Suburban Spine Center Lp, North Metro Surgery Center
$2,785.00Published rateEndoscopy Asc Of Middle Georgia LLC
$1,049.00Published rateAmbulatory Surgical Center Of Somerville LLC, Somerset Ambulatory Surgical Center
$778.00Published rateDallas Nephrology Associates, Dallas Nephrology Associates Vascular Center Dallas
Dallas Nephrology Associates, P.A.
$410.00Published rateSalvatore Dimercurio Md PA
Salvatore Dimercurio, M.D., P.A.
$100.00Published rate
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See a sample payer proposalCPT 43620 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43620 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 43620 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 |
|---|---|---|
| 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 |
| 43611-CPT | High | Excision, Local; Malignant Tumor Of Stomach |
| 43620-CPT | High | Remove Stomach Join To Bowel, Surgery To Remove The Stomach. The Procedure Includes The Formation Of A New Connection Between The Esophagus And The Intestine. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43620. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43620 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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