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See a sample rate comparisonCPT 43842 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.
Gastric Restrictive Procedure, Without Gastric Bypass, For Morbid Obesity; Vertical-Banded Gastroplasty -Medicaid Rn Review: Comm Rn Review=1/1/1996-3/27/2023
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43842 |
| Medicaid Fee Schedule | $936.02 median of the 8 states in the free preview · View Medicaid rates for 43842 |
National average reimbursement for CPT 43842 by major payers:
$1,520.32
$1,560.35
$1,604.95
$1,935.00
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CPT 43842
5 of 25 sample ratesHigher to lower in this preview
Mercy Hospitals East Communities, Mercy Outpatientsurgery Center Washington
Mercy Hospitals East Communities
$12,661.00Published rateShrewsbury Surgery Center, LLC, Shrewsbury Surgery Center
Shrewsbury Surgery Center LLC
$2,373.00Published rateSurgery Center Of Scottsdale, LLC, Mountain View Surgery Center Of Phoenix
Surgery Center Of Scottsdale LLC
$1,064.00Published rateColiseum Same Day Surgery Center Lp
$852.00Published rateEndoscopy Center -Pineville LLC, Carolina Endoscopy Center -Pineville
Endoscopy Center Pineville LLC
$285.00Published rate
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See a sample payer proposalCPT 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 | Stomach Bypass Surgery, Abdominal Surgery For Obesity To Reduce The Size Of The Stomach. The Procedure Involves Constructing A Passage (Bypass) That Moves Food Around The Outside Of The Stomach To Reduce Absorption. A Part Of The Intestines May Be Reconstructed. |
| 43846-CPT | High | Stomach Bypass Surgery, Abdominal Surgery For Obesity To Reduce The Size Of The Stomach. The Procedure Involves Constructing A Passage (Bypass) That Moves Food Around The Outside Of The Stomach To Reduce Absorption. A Part Of The Intestines May Be Reconstructed. |
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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