CPT 43865 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 • AG - Primary physician |
| Complexity Level | High |
| CMS | $1,664.87 Physician Fee Schedule |
National average reimbursement for CPT 43865 by major payers:
$1,994.26
$2,276.62
$2,370.07
$2,766.51
| 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 43865 | ||||||
United | 43865 | $110.00 | 1740287168 - AFFILIATED PHYSICIANS & SURGEONS, LTD | 860495569 - (AZ) AFFILIATED PHYSICIANS SURGEONS LTD | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $384.00 | 1164877684 - SMART PAIN SURGERY CENTER AT WHITE MARSH, CLEARWAY SURGERY CENTER OF WHITE MARSH | 812195231 - (MD) SMART PAIN SURGERY CENTER AT WHITE MARSH | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $1348.00 | 1518634732 - MEDSTAR HEALTH ENDOSCOPY CENTER | 872341245 - (MD) MEDSTAR HEALTH ENDOSCOPY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $1630.00 | 1881612042 - THE HAND AND UPPER EXTREMITY SURGERY CENTER OF GEORGIA, LLC | 200147862 - (GA) THE HAND AND UPPER EXTREMITY SURGERY CENTER OF GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $326.00 | 1780699546 - CASCADES ENDOSCOPY CENTER, LLC, WHITEMARSH ENDOSCOPY CENTER | 203496335 - (MD) CASCADES ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $788.00 | 1194344606 - TIDELANDS HEALTH ASC LLC, TIDELANDS HEALTH SURGERY CENTER AT THE MARKET COMMON | 611930163 - (SC) TIDELANDS HEALTH ASC LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $500.00 | 1780923128 - MACOMB ENDOSCOPY CENTER PLC | 275015226 - (MI) MACOMB ENDOSCOPY CENTER PLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $541.00 | 1225107014 - COMMONWEALTH EYE CLINIC INC | 611140257 - (KY) COMMONWEALTH EYE CLINIC INC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $501.00 | 1164448486 - CHRISTUS SANTA ROSA PASC-SAN ANTONIO LLC, CHRISTUS SANTA ROSA PHYSICIANS AMBULATORY SURGERY CENTER-STONE OAK | 412092141 - (TX) CHRISTUS SRPASC - SAN ANTONIO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $900.00 | 1730151168 - HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP, HAWTHORN SURGERY CENTER | 582065044 - (IL) HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $1080.00 | 1063595221 - SURGERY CENTER OF LOVELAND, LLC, LOVELAND SURGERY CENTER | 900985087 - (CO) SURGERY CENTER OF LOVELAND LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $390.00 | 1982186425 - CENTER FOR SPINE & PAIN MEDICINE PC, CSPM GSV ASC | 341976829 - CENTER FOR SPINE AND PAIN MEDICI | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $555.00 | 1063427706 - PROHEALTH AMBULATORY SURGERY CENTER INC | 113447394 - (NY) PROHEALTH AMBULATORY SURGERY CENTER INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $773.00 | 1962402503 - NORTH KITSAP AMBULATORY SURGERY CENTER, LLC, PACIFIC SURGERY CENTER | 911276412 - (WA) NORTH KITSAP AMBULATORY CENTER, INC. DBA PACIFIC SURGERY CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43865 | $2228.00 | 1184814782 - PUNXSUTAWNEY AREA HOSPITAL INC | 250965210 - (PA) PUNXSUTAWNEY AREA HOSPITAL INC | PA | 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 43865 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43865 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 43865 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 |
| 43830-CPT | Moderate | Gastrostomy Open W/O Gastric Tube Construction |
| 43865-CPT | High | 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 43865. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43865 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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