CPT 43845 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 • AS - PA/NP/CNS assistant at surgery • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43845 |
National average reimbursement for CPT 43845 by major payers:
$2,565.39
$2,605.68
$2,762.69
$3,206.98
| 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 43845 | ||||||
United | 43845 | $838.00 | 1720606932 - PHYSICIANS CLINIC INC | 470687317 - PHYSICIANS CLINIC INC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $100.00 | 1104894369 - VALLEY OUTPATIENT SURGICAL CENTER INC | 860585124 - (AZ) VALLEY OUTPATIENT SURGICAL CENTER INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $122.00 | 1225140510 - NORTHEAST AMBULATORY CENTER INC | 43382778 - (MA) NORTHEAST AMBULATORY CENTER, INC. | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $788.00 | 1013471754 - ADVANCED SURGERY CENTER OF LANCASTER, LLC | 831133719 - (PA) ADVANCED SURGERY CENTER OF LANCASTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $604.00 | 1447991138 - SILVER STATE SURGERY CENTER WEST LLC | 872764352 - (NV) SILVER STATE SURGERY CENTER WEST LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $1028.00 | 1366684326 - PRINCE FREDERICK SURGERY CENTER LLC | 264387021 - (MD) PRINCE FREDERICK SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $464.00 | 1346596566 - SCP INDIANAPOLIS LLC | 460639908 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $1344.00 | 1962568543 - ENDOSCOPY CENTER OF OCEAN COUNTY, LLC | 223461117 - (NJ) ENDOSCOPY CENTER OF OCEAN COUNTY, PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $559.00 | 1619487782 - UCH VASCULAR ACCESS ASC LLC | 820975009 - (TN) UCH VASCULAR ACCESS ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $1313.00 | 1669079992 - WOODBURY SURGERY CENTER, LLC | 853366699 - (MN) WOODBURY SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $744.00 | 1891865077 - REGENCY SURGERY CENTER, LLC | 710973677 - (CA) REGENCY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $1134.00 | 1174999700 - ADVANCED SURGERY CENTER OF CENTRAL IOWA, LLC | 472673565 - (IA) ADVANCED SURGERY CENTER OF CENTRAL IOWA LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $9124.00 | 1154454205 - TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE | 751748586 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $175.00 | 1144842394 - NATIONAL CARDIOVASCULAR SURGERY CENTER, LLC, PEAK SURGERY CENTER OF AVONDALE | 843454423 - (AZ) NATIONAL CARDIOVASCULAR SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43845 | $1955.00 | 1336459353 - LONE STAR ENDOSCOPY CENTER LLC | 273635726 | TX | 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 43845 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43845 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 43845 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 43845. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43845 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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