CPT 43635 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • 11 - Office |
| Common Modifiers | • None • 80 - Assistant surgeon • 82 - Assistant surgeon - no qualified resident • AS - PA/NP/CNS assistant at surgery • GC - Service performed by resident under supervision |
| Complexity Level | Low |
| CMS | $108.68 Physician Fee Schedule |
National average reimbursement for CPT 43635 by major payers:
$146.98
$153.90
$158.27
$185.12
| 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 43635 | ||||||
United | 43635 | $1064.00 | 1972092146 - SURGERY CENTRE OF SW FLORIDA LLC, FORT MYERS SURGERY CENTER | 454068750 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $235.00 | 1457683914 - ATHENS EYE SURGERY CENTER,LLC | 271467225 - (GA) ATHENS EYE SURGERY CENTERLLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $2737.00 | 1801859970 - LOS GATOS SURGICAL CENTER, A CALIFORNIA LIMITED PARTNERSHIP | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $1299.00 | 1083785398 - OLYMPIA ORTHOPAEDIC ASSOCIATES PLLC, OLYMPIA SURGERY CENTER LLC | 911674528 - OLYMPIA ORTHOPAEDIC ASSOCIATES, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $658.00 | 1447271713 - COLUMBUS ORTHOPEDIC OUTPATIENT | 900069344 - (MS) COLUMBUS ORTHOPEDIC OUTPATIENT | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $650.00 | 1871016071 - PORTNEUF ASC, LLC | 611847517 - (ID) PORTNEUF ASC LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $1049.00 | 1942264619 - METROPOLITAN MEDICAL PARTNERS LLC, SURGERY CENTER OF CHEVY CHASE | 522303928 - (MD) METROPOLITAN MEDICAL PARTNERS LL | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $1029.00 | 1952648966 - WENATCHEE VALLEY HOSPITAL, CONFLUENCE HEALTH OMAK ASC | 455563741 - WENATCHEE VALLEY HOSPITAL | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $147.00 | 1770753998 - SKIN CANCER TREATMENT CENTER, L.L.C. | 262051034 - (MD) SKIN CANCER TREATMENT CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $17689.00 | 1053770149 - AURORA SURGERY CENTERS, LLC | 811401714 - (WI) AURORA SURGERY CENTERS LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $364.00 | 1548655053 - MISSISSIPPI UROLOGY OUTPATIENT SURGERY CENTER, LLC | 463162562 - (MS) MISSISSIPPI UROLOGY OUTPATIENT SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $1275.00 | 1134665193 - NHPE, LLC, NEW HYDE PARK ENDOSCOPY | 471158058 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $1339.00 | 1043283906 - NAUGATUCK VALLEY ENDOSCOPY CENTER, LLC, WATERBURY SURGERY CENTER | 260078381 - (CT) NAUGATUCK VALLEY ENDOSCOPY CENTE | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $525.00 | 1689646937 - OCALA ENDOSCOPY ASC LP, ENDOSCOPY CENTER OF OCALA | 621650750 - (FL) OCALA ENDOSCOPY ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43635 | $1169.00 | 1194091801 - UNITY LINDEN OAKS SURGERY CENTER, LLC | 800798208 | NY | 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 43635 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43635 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 43635 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 |
|---|---|---|
| 43631-CPT | High | Gastrectomy, Partial, Distal; With Gastroduodenostomy |
| 43633-CPT | High | Gastrectomy, Partial, Distal; With Roux-En-Y Reconstruction |
| 43634-CPT | High | Gastrectomy, Partial, Distal; With Formation Of Intestinal Pouch |
| 43635-CPT | Low | Hemigastrectomy Or Distal Subtotal Gastrectomy Including Pyloroplasty, Gastroduodenostomy Or Gastrojejunostomy; W |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43635. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43635 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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