CPT 43647 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
National average reimbursement for CPT 43647 by major payers:
$2,475.35
$956.06
$774.45
$1,786.54
| 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 43647 | ||||||
United | 43647 | $1421.00 | 1447234919 - GENGASTRO LLC, ENDOSCOPY CENTER FOR DIGESTIVE HEALTH | 562315623 - (IA) GENGASTRO LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $6000.00 | 1437102241 - SURGERY CENTER OF FREMONT, LLC | 203639614 - (NE) SURGERY CENTER OF FREMONT LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $9834.00 | 1629032446 - AMBULATORY SURGERY CENTER GROUP LTD | 592073099 - (FL) AMBULATORY SURGERY CENTER GROUP LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $9834.00 | 1184051088 - SAN ANTONIO SURGICENTER, LLC, THE CENTER FOR SPECIAL SURGERY AT TCA | 300796793 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $3940.00 | 1457725392 - THE ENDOSCOPY CENTER OF QUEENS INC | 262427823 - (NY) THE ENDOSCOPY CENTER OF QUEENS INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $1248.00 | 1043216617 - TRIAD SURGERY CENTER LLC, TRIAD EYE MEDICAL CLINIC AND CATARACT INSTITUTE PLLC | 465002052 - (OK) TRIAD EYE INSTITUTE, PLLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $3940.00 | 1306162920 - SOUTH TEXAS AMBULATORY SURGERY CENTER, PLLC | 272293402 - (TX) SOUTH TEXAS AMBULATORY SURGERY CENTER PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $7426.00 | 1942231204 - SURGICAL INSTITUTE, LLC | 810911558 - (NJ) SURGICAL INSTITUTE LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $3898.00 | 1871529388 - PRG DALLAS ASC, LLC, CENTRAL POINT SURGERY CENTER | 752835144 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $9834.00 | 1063007573 - GEORGIA EYE SURGICENTER, LLC, GEORGIA EYE INSTITUTE SURGERY CENTER | 861925762 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $4104.00 | 1093731101 - EAST BRUNSWICK SURGERY CENTER LLC, UNIVERSITY SURGICENTER | 20593133 - (NJ) EAST BRUNSWICK SURGERY CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $11543.00 | 1376595421 - OTAY LAKES SURGERY CENTER, LLC | 200794766 - (CA) OTAY LAKES SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $7880.00 | 1740681733 - SURGCENTER OF GREATER PHOENIX, LLC | 465683789 - (AZ) SURGCENTER OF GREATER PHOENIX LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $29944.00 | 1609056290 - UCSD AMBULATORY SURGERY CENTER, LLC, UNIVERSITY AMBULATORY SURGERY CENTER | 261232189 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43647 | $8460.00 | 1710037452 - ILLINOIS SPORTS MEDICINE & ORTHOPEDIC SURGERY CENTER, LLC | 201054630 - (IL) ILLINOIS SPORTS MEDICINE AND ORTHOPEDIC SURGERY CENTER, LLC | IL | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 43647 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43647 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 43647 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 & 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) |
| 43647-CPT | High | Once Per Dos Lap Surgical; Implant/Replace Gastric Neurostimulator Electrodes, Antrum - Nurse Review>12/30/2022: Deny Inv/N10=1/1/2007-12/30/2022 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43647. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43647 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43647) and we'll show you how you compare in 15 minutes or less.