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See a sample rate comparisonCPT 43831 Fee Schedule
Last Verified: October 2026
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.
Gastrostomy Open W/O Gastric Tube Construction; Neonatal
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures 80 - Assistant surgeon |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $598.88 national non-facility rate (2026) · View Medicare rates for 43831 |
| Medicaid Fee Schedule | $467.62 median of the 8 states in the free preview · View Medicaid rates for 43831 |
National average reimbursement for CPT 43831 by major payers:
$723.17
$787.98
$835.99
$967.39
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CPT 43831
5 of 25 sample ratesHigher to lower in this preview
Trident Ambulatory Surgery Center, L.P.
Trident Ambulatory Surgery Center Lp
$5,250.00Published rateSurgical Eye Experts, LLC, Surgical Eye Experts Of New England, LLC
Surgical Eye Experts LLC
$1,245.00Published rateNorth Richland Hills Endoscopy Center LLC, Digestive Health Center Of North Richland Hills
North Richland Hills Endoscopy Center LLC
$1,022.00Published rateCenter For Digestive Health
The Center For Digestive Health, LLC
$650.00Published rateArizona Eye Institute & Cosmetic Laser Center LLC
Arizona Eye Institute Cosmetic Laser Center LLC
$382.00Published rate
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See a sample payer proposalCPT 43831 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43831 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 43831 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 |
|---|---|---|
| 43830-CPT | Moderate | Gastrostomy Open; W/O Construct Of Gastric Tube (Eg Stamm Pro, Gastrostomy Open; Without Construction Of Gastric Tube (Eg Stamm Pro |
| 43831-CPT | Moderate | Gastrostomy Open W/O Gastric Tube Construction; Neonatal |
| 43832-CPT | High | Gastrostomy Open; W/ Construct Of Gastric Tube (Eg Janeway Proc, Gastrostomy Open; With Construction Of Gastric Tube (Eg Janeway Proc |
| 43840-CPT | High | Gstrorrhaphy Suture Of Perforat Duodenal Or Gastric Ulcer Wound, Gastrorrhaphy Suture Of Perforated Duodenal Or Gastric Ulcer Wound |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43831. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43831 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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