CPT 43641 Fee Schedule
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.
| 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 | • None • JZ - Zero drug amount discarded/not administered to any patient • AS - PA/NP/CNS assistant at surgery • 51 - Multiple procedures • 80 - Assistant surgeon |
| Complexity Level | High |
| CMS | $1,178.38 Physician Fee Schedule |
National average reimbursement for CPT 43641 by major payers:
$1,557.16
$1,590.95
$1,670.31
$1,949.48
| 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 43641 | ||||||
United | 43641 | $624.00 | 1306013925 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $540.00 | 1710081443 - VENTURA ENDOSCOPY CENTER LLC | 680543503 - (CA) VENTURA ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $120.00 | 1447685458 - CHECKERSPOT SURGERY CENTERS, LLC | 463181931 - (MD) CHECKERSPOT SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $500.00 | 1427052026 - SUMMIT ENDOSCOPY CENTER | 582508201 - (GA) SUMMIT ENDOSCOPY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $1500.00 | 1437794625 - VANCE THOMPSON VISION SURGERY CENTER BILLINGS, LLC | 843362063 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $1064.00 | 1598083594 - MID-STATE ENDOSCOPY CENTER LLC | 270673692 - (TN) MIDSTATE ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $13332.00 | 1649456021 - POLARIS SURGERY CENTER, LLC, POLARIS SURBERY CENTER | 208074623 - (OH) POLARIS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $1680.00 | 1275067068 - UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER, INC, UMHCSC ASC EPISODIC BUNDLE | 465444821 - (MN) UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $410.00 | 1437636636 - CCRM DFW, LLC, CCRM DALLAS FORT WORTH | 822959456 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $1912.00 | 1730563610 - SACRAMENTO MIDTOWN ENDOSCOPY CENTER, LLC | 364811322 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $380.00 | 1881704237 - WATERFRONT SURGERY CENTER LLC | 251898743 - (PA) WATERFRONT SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $430.00 | 1598189342 - MEI SURGERY CENTER LLC, MICHIGAN EYE SURGERY CENTER | 461591012 - (MI) MEI SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $2172.00 | 1649793613 - BAYLOR SURGICARE AT BLUE STAR, LLC | 812931756 - (TX) BAYLOR SURGICARE AT BLUE STAR LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $645.00 | 1679963912 - FERTILITY LAB SCIENCES OF ORANGE COUNTY, LLC | 464731184 - (CA) FERTILITY LAB SCIENCES OF ORAN | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43641 | $2302.00 | 1336790237 - AURORA ENDOSCOPY SURGICENTER, LLC | 825396997 - (CO) AURORA ENDOSCOPY SURGICENTER LLC | CO | 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 43641 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43641 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 43641 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 | Hemigastrectomy Or Distal Subtotal Gastrectomy Including Pyloroplasty, Gastroduodenostomy Or Gastrojejunostomy; W |
| 43640-CPT | High | Vagotomy & Pyloroplasty-Truncal |
| 43641-CPT | High | Vag.W/Pyloroplasty;Parietal Cell |
| 43644-CPT | High | Laparoscopy Surgical Gastric Restrictive Pro- Cedure; With Gastric Bypass And Roux-En-Y Gastro- Enterostomy (Roux Limb 150 Cm Or Less) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43641. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43641 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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