CPT 43842 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 |
| Common Modifiers | • None |
| Complexity Level | High |
| CMS | $1,118.87 Physician Fee Schedule |
National average reimbursement for CPT 43842 by major payers:
$1,520.32
$1,560.35
$1,604.95
$1,935.00
| 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 43842 | ||||||
United | 43842 | $582.00 | 1639456973 - PHYSICIAN SURGERY CENTER OF ALBUQUERQUE LLC, POSC OF ABQ LLC | 273193930 - (NM) PHYSICIAN SURGERY CENTER OF ALBUQUERQUE LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $750.00 | 1194960732 - ISURGERY, LLC | 300514883 - (SD) ISURGERY LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $457.00 | 1891772547 - NOVAMED SURGERY CENTER OF BATON ROUGE LLC, INTERVENTIONAL PAIN MANAGEMENT CENTER | 262609309 - (LA) NOVAMED SURGERY CENTER OF BATON ROUGE LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $592.00 | 1508210378 - APEX MEDICAL SURGERY CENTER, LLC | 471906463 - (GA) APEX MEDICAL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $784.00 | 1104993799 - SURGERY CENTER OF FORT COLLINS LLC | 841541559 - (CO) SURGERY CENTER OF FORT COLLINS, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $1049.00 | 1184687386 - DIGESTIVECARE, LLC, DIGESTIVECARE ENDOSCOPY UNIT | 311108485 - (OH) DIGESTIVE CARE, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $600.00 | 1427183664 - LAGRECA EYE CLINIC, P.C., THE EYE CLINIC SURGICENTER | 320016290 - LAGRECA EYE CLINIC, PC | WY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $954.00 | 1376164475 - ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP, RIDGEWOOD ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO | 742976746 - (TX) ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $1148.00 | 1447293113 - WESTERN AMBULATORY SURGERY LLC | 830303151 - (WY) WESTERN AMBULATORY SURGERY LLC | WY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $728.00 | 1003015843 - NORTHBAY PHYSICIAN'S SURGERY CENTER, L.L.C. | 203502901 - (CA) NORTHBAY PHYSICIANS SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $297.00 | 1346508520 - FIRST GI ENDOSCOPY AND SURGERY CENTER LLC | 270870899 - (NJ) FIRST GI ENDOSCOPY AND SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $504.00 | 1003168907 - CANDESCENT EYE HEALTH SURGICENTER, LLC | 460608742 | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $525.00 | 1487158796 - CENTRIC AMBULATORY SURGERY CENTER LLC | 824465250 - (MO) CENTRIC AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $1028.00 | 1811433410 - OPHTHALMOLOGY SURGERY CENTER OF ORLANDO LLC, ORLANDO OPHTHALMOLOGY SURGERY CENTER | 814378043 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43842 | $224.00 | 1255303517 - ST DOMINIC AMBULATORY SURGERY CENTER L L C | 640908713 - (MS) ST DOMINIC AMBULATORY SURGERY CENTER L L C | MS | 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 43842 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43842 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 43842 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 |
|---|---|---|
| 43842-CPT | High | Gastric Restrictive Procedure, Without Gastric Bypass, For Morbid Obesity; Vertical-Banded Gastroplasty -Medicaid Rn Review: Comm Rn Review=1/1/1996-3/27/2023 |
| 43843-CPT | High | Gastric Restrictive Procedure, Without Gastric Bypass, For Morbid Obesity; Other Than Vertical-Banded Gastroplasty -Medicaid Rn Review: Comm Rn Review=1/1/1996-3/27/2023 |
| 43845-CPT | High | Gastric Restrictive Procedure With Partial Gastrectomy, Pylorus-Preserving Duodenoileostomy And Ileoileostomy (50 To 100 Cm Common Channel) To Limit Absorption (Biliopancreatic Diversion With Duodenal Switch) |
| 43846-CPT | High | Gastric Restrictive Procedure, With Gastric Bypass For Morbid Obesity; With Short Limb Roux-En-Y Gastroenterostomy -Medicaid Rn Review: Comm Rn Review=1/1/1996-3/27/2023 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43842. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43842 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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