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See a sample rate comparisonCPT 43645 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.
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.
| 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 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | $1,718.14 national non-facility rate (2026) · View Medicare rates for 43645 |
| Medicaid Fee Schedule | $1,337.195 median of the 8 states in the free preview · View Medicaid rates for 43645 |
National average reimbursement for CPT 43645 by major payers:
$2,324.37
$2,475.26
$2,579.41
$2,957.72
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CPT 43645
5 of 25 sample ratesHigher to lower in this preview
Inova Woodburn Surgery Center LLC
Inova Health Care Services
$9,674.00Published rateMosc, LLC
Mosc LLC
$4,124.00Published rateMacon Vascular Care, LLC
Macon Vascular Care LLC
$3,239.00Published rateVascare
Vascare Mayfair LLC
$1,922.00Published rateDeer Creek Surgery Center, LLC
$791.00Published rate
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See a sample payer proposalCPT 43645 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43645 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 43645 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 |
|---|---|---|
| 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. |
| 43645-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 43645. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43645 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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