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See a sample rate comparisonCPT 43640 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.
Vagotomy Inclu Pyloroplasty W//W/O Gastrostomy; Truncal, Vagotomy Including Pyloroplasty With Or Without Gastrostomy; Truncal
| 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 | 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | $1,121.60 national non-facility rate (2026) · View Medicare rates for 43640 |
| Medicaid Fee Schedule | $874.575 median of the 8 states in the free preview · View Medicaid rates for 43640 |
National average reimbursement for CPT 43640 by major payers:
$1,465.70
$1,563.00
$1,618.35
$1,881.75
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CPT 43640
5 of 25 sample ratesHigher to lower in this preview
Polaris Surgery Center, LLC, Polaris Surbery Center
Polaris Surgery Center LLC
$13,332.00Published rateQueensridge Surgery Center
$1,282.00Published rateSansum Clinic, Foothill Surgery Center At Sansum Clinic
Sansum Clinic
$949.00Published rateAsc Development Company LLC
$565.00Published rateMesa Az Endoscopy Asc LLC, Desert Endoscopy Center
The Mesa Az Endoscopy Asc, LLC
$103.00Published rate
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See a sample payer proposalCPT 43640 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43640 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 43640 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 |
|---|---|---|
| 43635-CPT | Low | Surgery On Nerve In Abdomen, Surgery To Cut The Vagus Nerve A Major Nerve That Runs Through The Abdomen To The Stomach And Intestines. The Procedure Includes Partial Removal Of The Stomach. |
| 43640-CPT | High | Vagotomy Inclu Pyloroplasty W//W/O Gastrostomy; Truncal, Vagotomy Including Pyloroplasty With Or Without Gastrostomy; Truncal |
| 43641-CPT | High | Vagotomy Inclu Pyloroplasty W//W/O Gastrostomy; Parietal, Vagotomy Including Pyloroplasty With Or Without Gastrostomy; Parietal |
| 43644-CPT | High | Stomach Weight Loss Surgery, Stomach Surgery Aided By A Scope (Laparoscope). The Procedure Reduces The Size Of The Stomach Or Creates A Route For Food That Bypasses The Stomach. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43640. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43640 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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