CPT 43881 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 • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | High |
National average reimbursement for CPT 43881 by major payers:
$2,891.35
$1,031.63
$857.08
$1,841.33
| 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 43881 | ||||||
United | 43881 | $528.00 | 1437601200 - UROPARTNERS SURGERY CENTER, LLC | 814131096 - (IL) UROPARTNERS SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $1955.00 | 1013227248 - TUSCAN SURGERY CENTER AT LAS COLINAS, LLC, TUSCAN SURGERY CENTER AT LAS COLINAS | 273578014 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $4251.00 | 1164776266 - UNIVERSITY OF KANSAS HOSPITAL | 481202402 - UNIVERSITY OF KANSAS HOSPITAL AUTHORITY | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $874.00 | 1427094945 - TRI-STATE SURGERY CENTER LLC | 562317091 - TRI STATE SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $2652.00 | 1639850415 - MEDICAL CITY SURGERY CENTER OF ALLEN, LLC | 932106228 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $1215.00 | 1780613521 - LITCHFIELD HILLS SURGERY CENTER | 562441789 - (CT) LITCHFIELD HILLS SURGERY CENTER | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $1572.00 | 1700419678 - METHODIST MANSFIELD AMBULATORY SURGERY CENTER, LLC | 260869371 - (TX) METHODIST MANSFIELD AMBULATORY SURGERY CENTER LL | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $514.00 | 1396738936 - WARREN GASTRO ENDOSCOPY CTR INC | 341850936 - (OH) WARREN GASTRO ENDOSCOPY CTR INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $1146.00 | 1770008922 - BANNER PHOENIX SURGERY CENTER LLC | 901182683 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $250.00 | 1871531244 - NORTH HOUSTON ENDOSCOPY & SURGERY | 760688879 - (TX) NORTH HOUSTON ENDOSCOPY SURGERY | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $400.00 | 1629107545 - LANIER EYE ASSOCIATES, LLC, ADVANCED EYE SURGERY AND LASER CENTER | 50559435 - (GA) LANIER EYE ASSOCIATES LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $873.00 | 1689905515 - FREMONT AMBULATORY SURGERY CENTER, L.P. | 943235450 - (CA) FREMONT AMBULATORY SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $687.00 | 1174938344 - SPECIALTY SURGERY CENTER, LLC | 455554765 - (MS) SPECIALTY SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $443.00 | 1124492996 - MOHS AND SKIN SURGERY CENTER, LLC | 474284353 - (MD) MOHS AND SKIN SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43881 | $2063.00 | 1720118102 - CENTRAL LOUISIANA AMBULATORY SURGICAL CENTER LLC | 264732898 - (LA) CENTRAL LOUISIANA SURGICAL HOSPITAL, LLC | LA | 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 43881 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43881 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 43881 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 Gastric Tube Construction |
| 43832-CPT | High | Gastrostomy Open W/Gastric Tube Construction |
| 43840-CPT | High | Gastrorrhaphy |
| 43881-CPT | High | Implantation Or Replacement Of Gastric Neurostimulator Electrodes, Antrum, Open - Nurse Review>12/30/2022: Deny Inv/N10=1/1/2007-12/30/2022 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43881. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43881 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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