CPT 43825 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 • 80 - Assistant surgeon • AS - PA/NP/CNS assistant at surgery • 58 - Staged or related procedure during postoperative period • AG - Primary physician • GC - Service performed by resident under supervision |
| Complexity Level | High |
| CMS | $1,281.57 Physician Fee Schedule |
National average reimbursement for CPT 43825 by major payers:
$1,592.55
$1,733.92
$1,803.71
$2,119.10
| 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 43825 | ||||||
United | 43825 | $283.00 | 1467089599 - CONWAY AMBULATORY SURGERY CENTER, LLC | 832516939 - (AR) CONWAY AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $535.00 | 1992018790 - REVISION ADVANCED SURGERY CENTER INC | 200734091 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $4825.00 | 1447489695 - AMBULATORY SURGERY CENTER AT VIRTUA WASHINGTON TOWNSHIP, L.L.C., VIRTUA CENTER FOR SURGERY | 208643005 - (NJ) AMBULATORY SURGERY CENTER AT VIRTUA WASHINGTON TOWNSHIP, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $1049.00 | 1104485440 - SURGCENTER OF GREATER JACKSONVILLE, LLC | 832504492 - (FL) SURGCENTER OF GREATER JACKSONVILLE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $6068.00 | 1982716106 - THR/STT SOUTHLAKE ASC, LLC | 201728912 - (TX) THRSTT SOUTHLAKE ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $600.00 | 1184689408 - EVERGREEN EYE CENTER, PLLC, EYE ASSOCIATES NORTHWEST SURGERY CENTER | 911610832 - (WA) EYE ASSOCIATES NORTHWEST, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $550.00 | 1912480070 - SOG SURGERY CENTER LLC | 822479805 - (MS) SOG SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $7400.00 | 1861657256 - INDIANA ENDOSCOPY CENTERS LLC | 208398421 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $393.00 | 1013513308 - JOHN KENYON AMERICAN EYE INSTITUTE LLC, EYE SURGERY CENTER OF ELIZABETHTOWN | 351907389 - JOHN-KENYON AMERICAN EYE INSTITUTE | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $746.00 | 1346331329 - PHYSICIANS EYE SURGERY CENTER LLC, PHYSICIANS' EYE SURGERY CENTER | 571116347 - (SC) PHYSICIANS EYE SURGERY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $459.00 | 1295088292 - CADENCE AMBULATORY SURGERY CENTER, LLC | 800838376 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $492.00 | 1467883496 - KILLER BEES LLC, BLUEGRASS SURGERY AND LASER CENTER | 201075292 | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $477.00 | 1871529388 - PRG DALLAS ASC, LLC, CENTRAL POINT SURGERY CENTER | 752835144 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $280.00 | 1275836645 - BROOKSTONE AMBULATORY SURGERY CENTER | 263097292 - (GA) BROOKSTONE AMBULATORY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43825 | $2575.00 | 1790130672 - PROSPECT DCMH, LLC, SHORT PROCEDURE UNIT | 811520273 | PA | 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 43825 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43825 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 43825 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43825. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43825 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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