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See a sample rate comparisonCPT 43634 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 24 - Ambulatory Surgical Center |
| Common Modifiers | AS - PA/NP/CNS assistant at surgery 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | $1,961.97 national non-facility rate (2026) · View Medicare rates for 43634 |
| Medicaid Fee Schedule | $1,515.06 median of the 8 states in the free preview · View Medicaid rates for 43634 |
National average reimbursement for CPT 43634 by major payers:
$2,587.44
$2,775.23
$2,900.51
$3,392.70
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CPT 43634
5 of 25 sample ratesHigher to lower in this preview
Sugar Land Surgery Center Ltd
$2,785.00Published rateCenter For Orthopedic Surgery, LLC
Center For Orthopedic Surgery LLC
$902.00Published rateSouth Sound Surgery, PLLC, Auburn Surgical Center
South Sound Surgery PLLC
$650.00Published rateHead And Neck Surgery Associates, Psc, Center For Surgical Care
Head & Neck Surgery Assoc., Psc
$520.00Published rateDiscover Vision Surgery & Laser Center LLC, Discover Vision Surgery & Laser Center
Discover Vision Surgery Laser Center LLC
$75.00Published rate
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See a sample payer proposalCPT 43634 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43634 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 43634 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 |
|---|---|---|
| 43622-CPT | High | Gastrectomy Total; W/ Formation Of Intestin Pouch Any Typ, Gastrectomy Total; With Formation Of Intestinal Pouch Any Type |
| 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. |
| 43634-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 43634. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43634 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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