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See a sample rate comparisonCPT 43860 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.
Revj Gstr/Jj Anast W/O Vgtmy, Revision Of Gastrojejunal Anastomosis (Gastrojejunostomy) With Reconstruction With Or Without Partial Gastrectomy Or Intestine Resection; Without Vagotomy
| 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 | $1,516.07 national non-facility rate (2026) · View Medicare rates for 43860 |
| Medicaid Fee Schedule | $1,183.35 median of the 8 states in the free preview · View Medicaid rates for 43860 |
National average reimbursement for CPT 43860 by major payers:
$2,003.68
$2,179.29
$2,286.34
$2,593.39
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CPT 43860
5 of 25 sample ratesHigher to lower in this preview
Peak One Surgery Center, LLC, Peak One Surgery Center
Peak One Surgery Center LLC
$9,210.00Published rateRenaissance Surgery Center, LLC
$1,274.00Published rateFremont Ambulatory Surgery Center, Lp
Fremont Ambulatory Surgery Center
$873.00Published rate1800 Mcdonough Road Surgery Center LLC
$550.00Published rateTampa Fl Endoscopy Asc LLC, Tampa Bay Endoscopy Center
Tampa Fl Endoscopy Asc LLC
$50.00Published rate
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See a sample payer proposalCPT 43860 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43860 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 43860 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 |
|---|---|---|
| 43820-CPT | High | Gastrojejunostomy |
| 43825-CPT | High | Gastrojejunostomy W Vagotomy |
| 43860-CPT | High | Revj Gstr/Jj Anast W/O Vgtmy, Revision Of Gastrojejunal Anastomosis (Gastrojejunostomy) With Reconstruction With Or Without Partial Gastrectomy Or Intestine Resection; Without Vagotomy |
| 43865-CPT | High | Revise Stomach Bowel Fusion, Revision Of Gastrojejunal Anastomosis Gastrojejunostomy With Reconstruction With Or Without Partial Gastrectomy Or Intestine Resection With Vagotomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43860. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43860 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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