CPT 43775 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43775 |
National average reimbursement for CPT 43775 by major payers:
$1,647.82
$1,626.28
$1,701.99
$1,925.92
| 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 43775 | ||||||
United | 43775 | $6588.00 | 1922611714 - COLORADO UROLOGIC SURGERY CENTER LLC | 851926897 - (CO) COLORADO UROLOGIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43775 | $1525.59 | 1750485009 - JAMES LABORDE | 463936183 - (LA) LMG, LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43775 | $10224.00 | 1841562709 - HH KILLEEN HEALTH SYSTEM LLC, SETON MEDICAL CENTER HARKER HEIGHTS | 272814378 - (TX) HH KILLEEN HEALTH SYSTEM LLC | TX | General Acute Care Hospital (282N00000X) |
United | 43775 | $3811.00 | 1548226442 - ARTHROSCOPIC & LASER SURGERY CENTER OF SAN DIEGO LP | 631166884 - (CA) ARTHROSCOPIC & LASER SURGERY CENTER OF SAN DIEGO, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43775 | $14780.00 | 1396779948 - TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | 751047527 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 43775 | $1764.00 | 1427098201 - SURGICARE OF LAKE CHARLES LLC, SURGICARE OF LAKE CHARLES | 621658994 - (LA) LAKE AREA SURGICARE LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43775 | $1230.77 | 1629497078 - KEVIN GOODSON | 592929608 - (FL) MUSCULOSKELETAL INSTITUTE INC. FLORIDA ORTHOPAEDIC INSTITUTE | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43775 | $2878.84 | 1104913912 - STEVEN KAUTZ | 364774713 - LSU HEALTH SCIENCES CENTER - SHREVEPORT FACULTY GROUP PRACTICE | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43775 | $1292.97 | 1639127335 - JORGE ISAZA | 474889697 - (LA) SPINE SPECIALISTS OF LOUISIANA | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43775 | $3000.00 | 1285065623 - STEPHENS MEMORIAL HOSPITAL DISTRICT, STEPHENS MEMORIAL HOSPITAL | 462931328 | TX | General Acute Care Hospital (282N00000X) |
United | 43775 | $15664.00 | 1932152337 - MEMORIAL HERMANN HEALTH SYSTEM, MEMORIAL HERMANN KATY HOSPITAL | 741152597 - (TX) MEMORIAL HERMANN HEALTH SYSTEM | TX | General Acute Care Hospital (282N00000X) |
United | 43775 | $1949.56 | 1710196548 - LARRY BANKSTON | 261531455 | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43775 | $1525.59 | 1104185958 - GUSTAVO GODOY | 463936183 - (LA) LMG, LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 43775 | $2900.00 | 1477949766 - DESCHUTES SURGERY CENTER, LLC, DESCHUTES SURGERY CENTER, LLC | 472920584 - (OR) DESCHUTES SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43775 | $5117.00 | 1144283292 - LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | 943419282 - (LA) LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | LA | 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 43775 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43775 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 43775 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 |
|---|---|---|
| 43770-CPT | High | Laparoscopy, Surgical, Gastric Restrictive Procedure; Placement Of Adjustable Gastric Restrictive Device (Eg, Gastric Band And Subcutaneous Port Components) |
| 43771-CPT | High | Laparoscopy, Surgical, Gastric Restrictive Procedure; Revision Of Adjustable Gastric Restrictive Device Component Only- Rn Review |
| 43772-CPT | High | Laparoscopy, Surgical, Gastric Restrictive Procedure; Removal Of Adjustable Gastric Restrictive Device Component Only -Medicaid Rn Review: Comm Rn Review=1/1/2006-3/27/2023 |
| 43775-CPT | High | Once Per Dos Laparoscopy, Surgical, Gastric Restrictive Procedure; Longitudinal Gastrectomy- Commercial Rn Review=1/1/2010-3/27/2023 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43775. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43775 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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