CPT 43756 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $256.18 Physician Fee Schedule |
National average reimbursement for CPT 43756 by major payers:
$279.93
$319.87
$350.00
$450.69
| 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 43756 | ||||||
United | 43756 | $670.00 | 1750352324 - SUNRISE AMBULATORY SURGICAL CENTER LLC | 943363471 - (AZ) SUNRISE AMBULATORY SURGICAL CENT | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $950.00 | 1053934919 - DOYLESTOWN SURGERY CENTER, LLC | 834549561 - (PA) DOYLESTOWN SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $553.00 | 1871514067 - GREENBELT UROLOGY INSTITUTE, L.L.C. | 203144771 - (MD) GREENBELT UROLOGY INSTITUTE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $1276.00 | 1568967131 - CENTRAL MAINE EYE SURGERY CENTER LLC | 824811437 - (ME) CENTRAL MAINE EYE SURGERY CENTER LLC | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $3022.00 | 1023359627 - THE EMORY CLINIC INC., EMORY AESTHETIC CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $1031.00 | 1871557652 - PORT ST LUCIE SURGERY CENTER LTD | 621600419 - (FL) PORT ST LUCIE SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $667.00 | 1114990231 - SURGERY CENTER OF MIDDLE TENNESSEE LLC, THE SURGERY CENTER OF MIDDLE TENNESSEE | 621839266 - (TN) SURGERY CENTER OF MIDDLE TENNESSEE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $3444.00 | 1770810798 - MIDTOWN SURGERY CENTER, LLC | 271462435 - (NY) MIDTOWN SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $2817.00 | 1003127606 - MEMORIAL HERMANN ENDOSCOPY CENTER NORTH FREEWAY LLC, MEMORIAL HERMANN ENDOSCOPY CENTER NORTH LOOP | 272800702 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $500.00 | 1023088473 - PANAMA CITY SURGERY CENTER,LLC | 481255983 - (FL) PANAMA CITY SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $928.00 | 1154088490 - BSC 3 LLC, BANNER SURGERY CENTER - SPORTS MEDICINE | 871712552 - (AZ) BSC 3 LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $1123.00 | 1942472931 - SURGCENTER OF GLEN BURNIE, SURGCENTER OF GLEN BURNIE, LLC | 261572774 - (MD) SURGCENTER OF GLEN BURNIE, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $2199.00 | 1477900710 - BJOSC, LLC, BJOSC AT PLOVER | 300391378 - BJOSC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $550.00 | 1912480070 - SOG SURGERY CENTER LLC | 822479805 - (MS) SOG SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43756 | $1250.00 | 1003116823 - NORTHERN N.J. ENDOSCOPY CENTER, L.L.C. | 640955113 - (NJ) NORTHERN NJ ENDOSCOPY CENTER LLC | NJ | 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 43756 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43756 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 43756 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) |
| 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 |
| 43756-CPT | Moderate | Once Per Dos Duodenal Intubation And Aspiration, Diagnostic, Includes Image Guidance; Single Specimen (Eg, Bile Study For Crystals Or Afferent Loop Culture) |
| 43757-CPT | Moderate | Duodenal Intubation And Aspiration Diagnostic Includes Image Guidance; Single Specimen (Eg Bile Study For Crystals Or Afferent Loop Culture) Collection Of Mulitple Fractional Specimens With Pancreatic Or Gallbladder Stimulation Single Or Double Lumen Tube 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 43756. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43756 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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