CPT 43752 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 • 23 - Emergency Room |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | Low |
| CMS | $38.49 Physician Fee Schedule |
National average reimbursement for CPT 43752 by major payers:
$53.99
$55.57
$61.17
$69.19
| 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 43752 | ||||||
United | 43752 | $574.00 | 1326142878 - LEBANON ENDOSCOPY CENTER LLC, LEBANON ENDOSCOPY CENTER | 205449574 - (TN) LEBANON ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $70.00 | 1558787614 - DIGESTIVE CARE ENDOSCOPY | 464923646 - (GA) DIGESTIVE CARE ENDOSCOPY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $645.00 | 1649269663 - PHYSICIANS ALLIANCE LC, PHYSICIANS ALLIANCE SURGERY CENTER | 431832038 - (MO) PHYSICIANS ALLIANCE LC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $221.00 | 1972522985 - MIDDLESEX ENDOSCOPY CENTER LLC | 20722190 - (CT) MIDDLESEX ENDOSCOPY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $245.00 | 1588092605 - GOLD COAST SURGERY CENTER, CENTER FOR SPECIALIZED SURGERY OF SANTA BARBARA | 460639888 - GOLD COAST SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $150.00 | 1194255372 - DECATUR UROLOGY SURGERY CENTER | 814721108 - (GA) DECATUR UROLOGY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $1543.00 | 1336695188 - HHC HARTFORD SURGERY CENTER, LLC | 812637261 - (CT) HHC HARTFORD SURGERY CENTER, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $214.00 | 1194815639 - CEDAR ORTHOPAEDIC SURGERY CENTER, LLC | 200208975 - (UT) CEDAR ORTHOPAEDIC SURGERY CENTER LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $105.00 | 1366635609 - APPLE SURGERY CENTER, INC | 260423287 - (CA) APPLE SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $803.00 | 1558328096 - NEWPORT BEACH ENDOSCOPY CENTER, LLC | 770368744 - (CA) NEWPORT BEACH ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $566.00 | 1811433410 - OPHTHALMOLOGY SURGERY CENTER OF ORLANDO LLC, ORLANDO OPHTHALMOLOGY SURGERY CENTER | 814378043 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $108.00 | 1306938550 - WEST GEORGIA ENDOSCOPY CENTER | 753182533 - (GA) WEST GEORGIA ENDOSCOPY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $1800.00 | 1689635757 - ATLANTICARE SURGERY CENTER LLC | 223491867 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $250.00 | 1295365864 - NORTH FORK SURGERY CENTER LLC | 813251284 - (NY) NORTH FORK SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43752 | $688.00 | 1013068642 - RENAISSANCE SURGERY CENTER, LLC | 205977652 - (CA) RENAISSANCE SURGERY CENTER, LLC | CA | 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 43752 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43752 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 43752 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 |
|---|---|---|
| 43752-CPT | Low | Naso- Or Oro-Gastric Tube Placement Requiring Physicians Skill And Fluoroscopic Guidance (Includes Fluoroscopy Image Documentation And Report) (Rvsd 1/1/04) |
| 43753-CPT | Low | Once Per Dos Gastric Intubation And Aspiration(S) Therapeutic, Necessitating Physician's Skill (Eg, For Gastrointestinal Hemorrhage), Including Lavage If Performed |
| 43754-CPT | Low | Once Per Dos Gastric Intubation And Aspiration, Diagnostic; Single Specimen (Eg, Acid Analysis) |
| 43755-CPT | Moderate | Gastric Intubation And Aspiration, Diagnostic; Collection Of Multiple Fractional Specimens With Gastric Stimulation, Single Or Double Lumen Tube (Gastric Secretory Study) (Eg, Histamine, Insulin, Pentagastrin, Calcium, Secretin), Includes Drug Administration |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43752. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43752 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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