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See a sample rate comparisonCPT 43631 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.
Surgery To Remove Stomach Part, Surgery To Remove A Section Of The Stomach. The Procedure Involves Creation Of A New Connection To The Intestines.
| 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 | AS - PA/NP/CNS assistant at surgery 52 - Reduced Services |
| Complexity Level | High |
| Medicare Fee Schedule | $1,355.74 national non-facility rate (2026) · View Medicare rates for 43631 |
| Medicaid Fee Schedule | $1,058.19 median of the 8 states in the free preview · View Medicaid rates for 43631 |
National average reimbursement for CPT 43631 by major payers:
$1,736.31
$1,934.66
$1,981.39
$2,305.78
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CPT 43631
5 of 25 sample ratesHigher to lower in this preview
North Dallas Surgical Center,LLC, Texas Health Surgery Center Addison
North Dallas Surgical Centerllc
$6,068.00Published rateBaptist Plaza Surgicare Lp, Saint Thomas Surgery Center - Midtown
$1,420.00Published rateSurgcenter Tucson, LLC
$1,028.00Published rateJohns Hopkins Surgery Centers Series
Johns Hopkins Surgery Center Series
$600.00Published rateYuma Valley Ambulatory Pain Services Inc
$100.00Published rate
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See a sample payer proposalCPT 43631 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43631 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 43631 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 |
|---|---|---|
| 43621-CPT | High | Gastrectomy, Total; With Roux-En-Y Reconstruction |
| 43631-CPT | High | Surgery To Remove Stomach Part, Surgery To Remove A Section Of The Stomach. The Procedure Involves Creation Of A New Connection To The Intestines. |
| 43632-CPT | High | Surgery To Remove Stomach Part, Surgery To Remove A Section Of The Stomach. The Procedure Involves Creation Of A New Connection To The Intestines. |
| 43633-CPT | High | Surgery To Remove Stomach Part, Surgery To Remove A Section Of The Stomach. The Procedure Involves Creation Of A New Connection To The Intestines. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43631. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43631 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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