CPT 43761 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 • ET - Emergency services |
| Complexity Level | Low |
| CMS | $118.71 Physician Fee Schedule |
National average reimbursement for CPT 43761 by major payers:
$156.93
$162.52
$172.71
$200.33
| 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 43761 | ||||||
United | 43761 | $100.00 | 1033115472 - CAPLAN-BERKELEY, LLP, CAPLAN SURGERY CENTER | 571146952 - (TX) CAPLANBERKELEY LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $135.00 | 1902447386 - SEATTLE PAIN RELIEF PLLC, FEDERAL WAY AMBULATORY SURGICAL FACILITY | 455527273 - (WA) SEATTLE PAIN RELIEF PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $200.00 | 1083606867 - NOVAMED SURGERY CENTER OF TYLER, LP, CATARACT CENTER OF EAST TEXAS | 680510003 - (TX) NOVAMED SURGERY CENTER OF TYLER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $1708.00 | 1689639692 - SURGICAL CENTER OF SOUTH JERSEY LIMITED PARTNERSHIP | 222709324 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $1070.00 | 1629249172 - NORTH STATE SURGERY CENTERS LP, COURT STREET SURGERY CENTER | 300197423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $77.00 | 1043375702 - HAZLETON ENDOSCOPY CENTER, INC. | 233074102 - (PA) HAZLETON ENDOSCOPY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $80.00 | 1497895361 - MADHU K. KRIS M.D., MERCED AMBULATORY ENDOSCOPY CENTER | 770095000 - (CA) MADHU K KRIS MD | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $531.00 | 1730318353 - GARDENDALE SURGICAL ASSOCIATES, LLC | 205936644 - (AL) GARDENDALE SURGICAL ASSOCIATES | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $562.00 | 1457725392 - THE ENDOSCOPY CENTER OF QUEENS INC | 262427823 - (NY) THE ENDOSCOPY CENTER OF QUEENS INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $106.00 | 1306199757 - SONTERRA PROCEDURE CENTER, LLC | 455125802 - (TX) SONTERRA PROCEDURE CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $300.00 | 1073987053 - SERENITY SURGICAL, LLC | 471546645 - (IN) SERENITY SURGICAL, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $106.00 | 1619049939 - ENDOSCOPY CENTER MONROE LLC, CAROLINA ENDOSCOPY CENTER MONROE | 260731594 - (NC) ENDOSCOPY CENTER MONROE LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $305.00 | 1033250618 - MCDOWELL AMBULATORY SURGERY CENTER LLC | 261184708 - (AZ) MCDOWELL AMBULATORY SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $88.00 | 1982744231 - SOUTHLAND ENDOSCOPY CENTER, SOUTHLAND ENDOSCOPY CENTER | 330607952 - (CA) SOUTHLAND ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43761 | $254.00 | 1396738936 - WARREN GASTRO ENDOSCOPY CTR INC | 341850936 - (OH) WARREN GASTRO ENDOSCOPY CTR INC | OH | 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 43761 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43761 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 43761 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 |
| 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 |
| 43761-CPT | Low | Repositioning Of A Naso- Or Oro-Gastric Feeding Tube, Through The Duodenum For Enteric Nutrition |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43761. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43761 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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