Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 43870 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Closure Gastrostomy Surgical
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | GC - Service performed by resident under supervision AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $673.70 national non-facility rate (2026) · View Medicare rates for 43870 |
| Medicaid Fee Schedule | $525.10 median of the 8 states in the free preview · View Medicaid rates for 43870 |
National average reimbursement for CPT 43870 by major payers:
$861.35
$937.75
$1,029.53
$1,129.42
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43870.
CPT 43870
5 of 25 sample ratesHigher to lower in this preview
Saint Luke'S North Surgery Center, LLC
Saint Lukes North Surgery Center LLC
$5,177.00Published rateCrown Point Surgery Center, LLC, Crown Point Surgery Center
Crown Point Surgery Center, LLC
$2,388.00Published rateBahamas Surgery Center LLC
$1,910.00Published rateJessica Mendel
Deaconess Hospital Inc
$1,231.09Published rateSouth Carolina Endoscopy Center
S.C. Endoscopy Center LLC
$550.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 43870 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43870 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 43870 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 |
|---|---|---|
| 43830-CPT | Moderate | Gastrostomy Open; W/O Construct Of Gastric Tube (Eg Stamm Pro, Gastrostomy Open; Without Construction Of Gastric Tube (Eg Stamm Pro |
| 43832-CPT | High | Gastrostomy Open; W/ Construct Of Gastric Tube (Eg Janeway Proc, Gastrostomy Open; With Construction Of Gastric Tube (Eg Janeway Proc |
| 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 |
| 43870-CPT | Moderate | Closure Gastrostomy Surgical |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43870. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43870 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43870) and we'll show you how you compare in 15 minutes or less.