CPT 43652 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 |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43652 |
National average reimbursement for CPT 43652 by major payers:
$993.04
$1,025.38
$1,056.86
$1,256.63
| 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 43652 | ||||||
United | 43652 | $2800.00 | 1477803724 - VALENCIA SPECIALTY SURGERY PC | 460979296 - (CA) VALENCIA SPECIALTY SURGERY PC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $1722.00 | 1174859516 - HERMITAGE TN ENDOSCOPY ASC, LLC, ASSOCIATED ENDOSCOPY | 270986942 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $1940.00 | 1740288679 - GULF COAST SURGICAL PARTNERS LLC | 631285913 - (AL) GULF COAST SURGICAL PARTNERS LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $2816.00 | 1497751747 - MID-ATLANTIC ENDOSCOPY CENTER, LLC, MID-ATLANTIC GASTROINTESTINAL CENTER II | 233096335 - (DE) MIDATLANTIC ENDOSCOPY CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $3458.00 | 1932709490 - LUNATE SURGERY CENTER | 853581951 - (GA) LUNATE SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $812.00 | 1184675704 - DOCTORS SURGERY CENTER LLC | 593518740 - (FL) DOCTORS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $980.00 | 1669577524 - SKIN & MOHS SURGERY CENTER, LLC | 431823843 - SKIN MOHS SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $6087.00 | 1881969269 - SURGERY CENTRE OF SW FLORIDA LLC, CAPE HEALTH SURGERY CENTER | 454068750 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $5660.00 | 1720227945 - WESTERN CONNECTICUT ORTHOPEDIC SURGICAL CENTER LLC, THE HAND CENTER OF WESTERN CONNECTICUT LLC | 61521999 - (CT) THE HAND CENTER OF WESTERN CONNECTICUT, L.L.C. | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $1904.00 | 1316976137 - CENTRAL MARYLAND ENDOSCOPY LLC | 201580201 - (MD) CENTRAL MARYLAND ENDOSCOPY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $3489.00 | 1013309459 - MELBOURNE SURGERY CENTER, LLC, MELBOURNE SURGERY CENTER | 582101921 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $6588.00 | 1891298089 - MICHIGAN OUTPATIENT SURGICAL SOLUTIONS, LLC | 821706937 - (MI) MICHIGAN OUTPATIENT SURGICAL SOLUTIONS LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $1073.00 | 1437129723 - AFFINITY OUTPATIENT SERVICES | 582189333 - (GA) AFFINITY HEALTH GROUP, L.L.C. | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $1599.00 | 1760020846 - FOUNDERS SURGERY CENTER, LLC | 843861807 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43652 | $5277.00 | 1760875983 - BAPTIST MEDICAL PARK SURGERY CENTER, LLC | 593535262 - (FL) BAPTIST MEDICAL PARK SURGERY CENTER LLC | FL | 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 43652 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43652 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 43652 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 |
|---|---|---|
| 43340-CPT | High | Esphagojejunostomy; Abdominal Approach |
| 43648-CPT | High | Laparoscopy, Surgical; Revision Or Removal Of Gastric Neurostimulator Electrodes, Antrum - Nurse Review>12/30/2022: Deny Inv/N10=1/1/2007-12/30/2022 |
| 43651-CPT | Moderate | Laparoscopy; Transection Of Vagus Nerves, Truncal |
| 43652-CPT | Moderate | Laparoscopy; Transection Of Vagus Nerves, Selective Or Highly Selectiv |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43652. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43652 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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