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See a sample rate comparisonCPT 43845 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.
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.
| 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 | AS - PA/NP/CNS assistant at surgery 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | $1,827.03 national non-facility rate (2026) · View Medicare rates for 43845 |
| Medicaid Fee Schedule | $1,422.485 median of the 8 states in the free preview · View Medicaid rates for 43845 |
National average reimbursement for CPT 43845 by major payers:
$2,565.39
$2,605.68
$2,762.69
$3,137.13
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CPT 43845
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Azle
$9,124.00Published rateAdvanced Surgery Center Of Central Iowa, LLC
Advanced Surgery Center Of Central Iowa LLC
$1,134.00Published rateDesert Ridge Outpatient Surgery LLC
$1,028.00Published rateUch Vascular Access Asc LLC
$559.00Published rateValley Outpatient Surgical Center Inc
$100.00Published rate
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See a sample payer proposalCPT 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 | 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 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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