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See a sample rate comparisonCPT 43840 Fee Schedule
Last Verified: October 2026
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.
Gstrorrhaphy Suture Of Perforat Duodenal Or Gastric Ulcer Wound, Gastrorrhaphy Suture Of Perforated Duodenal Or Gastric Ulcer Wound
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 23 - Emergency Room |
| Common Modifiers | GC - Service performed by resident under supervision 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | $1,272.57 national non-facility rate (2026) · View Medicare rates for 43840 |
| Medicaid Fee Schedule | $986.83 median of the 8 states in the free preview · View Medicaid rates for 43840 |
National average reimbursement for CPT 43840 by major payers:
$1,619.73
$1,767.50
$1,917.59
$2,125.17
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CPT 43840
5 of 25 sample ratesHigher to lower in this preview
Belleair Surgery Center Ltd
$6,734.00Published rateHorseshoe Surgery Center, LLC, Lakewood Surgery Center
Lakewood Surgery Center
$3,315.00Published rateOrthoatlanta Surgery Center Of Fayetteville, LLC
Orthoatlanta Surgery Center Of Fayetteville LLC
$2,502.00Published rateCpm Surgery Center LLC
$1,500.00Published rateEndoscopy Center Of Northeast Tennessee, PC
$425.00Published rate
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See a sample payer proposalCPT 43840 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43840 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 43840 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 |
|---|---|---|
| 43800-CPT | High | Widen Stomach Opening To Bowel, Surgery To Widen The Opening Of The Bottom Of The Stomach By Cutting The Muscles At The Junction Between The Stomach And The Small Intestine. |
| 43810-CPT | High | Gastroduodenostomy |
| 43830-CPT | Moderate | Gastrostomy Open; W/O Construct Of Gastric Tube (Eg Stamm Pro, Gastrostomy Open; Without Construction Of Gastric Tube (Eg Stamm Pro |
| 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 43840. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43840 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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