CPT 43886 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center • 21 - Inpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| CMS | $363.90 Physician Fee Schedule |
National average reimbursement for CPT 43886 by major payers:
$451.63
$472.97
$500.05
$611.28
| 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 43886 | ||||||
United | 43886 | $1763.00 | 1770019200 - GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC, GEORGIA CATARACT AND EYE SPECIALTY CENTER | 461115901 - (GA) GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $6460.00 | 1811101439 - SENTARA OBICI AMBULATORY SURGERY, LLC | 260144898 - (VA) SENTARA OBICI AMBULATORY SURGERY, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $1855.00 | 1306353586 - SDG CASTLE ROCK ENDOSCOPY CENTER | 823765778 - (CO) SDG CASTLE ROCK ENDOSCOPY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $1130.00 | 1376797332 - RENUE SURGERY CENTER LLC | 262423545 - (GA) RENUE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $2763.00 | 1902472715 - CENTRAL ARKANSAS RADIATION THERAPY INSTITUTE INC, CARTI SURGERY CENTER | 710437657 - (AR) CENTRAL ARKANSAS RADIATION THERAPY INSTITUTE INC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $3623.00 | 1386086411 - MARION SURGERY CENTER, LLC | 462447139 - (FL) MARION SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $1245.00 | 1336439645 - ACADEMIC UROLOGY OF PA, LLC | 205328092 - (PA) ACADEMIC UROLOGY OF PA, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $4140.00 | 1184689010 - PARK CITIES SURGERY CENTER, LLC, PARK CITIES SURGERY CENTER | 562357079 - (TX) PARK CITIES SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $2000.00 | 1912909169 - KIPS BAY ENDOSCOPY CENTER, LLC | 134243635 - (NY) KIPS BAY ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $1141.00 | 1770151722 - SPECIALTY SURGERY PARTNERS CENTER OF FLORIDA, LLC, ALLIANCE SPECIALTY SURGICAL CENTER | 863661396 - (FL) SPECIALTY SURGERY PARTNERS CENTER OF FLORIDA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $1069.00 | 1720161771 - EYE CARE SURGERY CENTER OF OLIVE BRANCH,LLC | 470920342 - (MS) EYE CARE SURGERY CENTER OF OLIVE BRANCHLLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $2585.00 | 1922301712 - THE SURGERY CENTER AT WILLIAMSON LLC | 270929515 - (TX) THE SURGERY CENTER AT WILLIAMSON LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $2792.00 | 1053565259 - SOUTHWEST LINCOLN SURGERY CENTER, LLC, SOUTHWEST LINCOLN SURGERY CENTER | 262981972 - (NE) SOUTHWEST LINCOLN SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $2175.00 | 1023104825 - VISION CARE OF MAINE-AROOSTOOK LLC | 270010026 - (ME) VISION CARE OF MAINEAROOSTOOK LLC | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43886 | $849.00 | 1366032617 - EMERSON ENDOSCOPY AND DIGESTIVE HEALTH CENTER, LLC | 843673604 - (MA) EMERSON ENDOSCOPY AND DIGESTIVE HEALTH CENTER LLC | MA | 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 43886 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43886 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 43886 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 |
|---|---|---|
| 43770-CPT | High | Laparoscopy, Surgical, Gastric Restrictive Procedure; Placement Of Adjustable Gastric Restrictive Device (Eg, Gastric Band And Subcutaneous Port Components) |
| 43771-CPT | High | Laparoscopy, Surgical, Gastric Restrictive Procedure; Revision Of Adjustable Gastric Restrictive Device Component Only- Rn Review |
| 43772-CPT | High | Laparoscopy, Surgical, Gastric Restrictive Procedure; Removal Of Adjustable Gastric Restrictive Device Component Only -Medicaid Rn Review: Comm Rn Review=1/1/2006-3/27/2023 |
| 43886-CPT | Moderate | Gastric Restrictive Procedure, Open; Revision Of Subcutaneous Port Component Only -Medicaid Rn Review: Comm Rn Review=1/1/2006-3/27/2023 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43886. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43886 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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