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See a sample rate comparisonCPT 43621 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.
Gastrectomy, Total; With Roux-En-Y Reconstruction
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 19 - Off Campus Outpatient Hospital |
| Common Modifiers | GC - Service performed by resident under supervision 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | $2,091.56 national non-facility rate (2026) · View Medicare rates for 43621 |
| Medicaid Fee Schedule | $1,619.93 median of the 8 states in the free preview · View Medicaid rates for 43621 |
National average reimbursement for CPT 43621 by major payers:
$2,823.97
$2,988.45
$3,232.56
$3,563.63
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CPT 43621
5 of 25 sample ratesHigher to lower in this preview
Cross Timbers Surgery Center, LLC, North Texas Gi Center
Cross Timbers Surgery Center, Lp Dba North Texas Gi Center
$6,068.00Published rateSummit Ambulatory Surgical Center LLC
$1,064.00Published rateIsurgery, LLC
Isurgery LLC
$750.00Published rateJoint Replacement Center Of Louisiana
Joint Replacement Center Of Lous
$451.00Published rateMidwest Eye Consultants, P.C., Cli Surgery Center
Midwest Eye Consultants, P.C.
$300.00Published rate
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See a sample payer proposalCPT 43621 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43621 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 43621 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 |
|---|---|---|
| 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. |
| 43621-CPT | High | Gastrectomy, Total; With Roux-En-Y Reconstruction |
| 43622-CPT | High | Gastrectomy Total; W/ Formation Of Intestin Pouch Any Typ, Gastrectomy Total; With Formation Of Intestinal Pouch Any Type |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43621. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43621 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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