CPT 43999 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43999 |
National average reimbursement for CPT 43999 by major payers:
$1,221.04
$152.15
$3,547.30
$1,213.55
| 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 43999 | ||||||
United | 43999 | $393.00 | 1811090350 - GREEN SURGERY CENTER LLC | 621770173 - (TN) GREEN SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $1077.00 | 1083050603 - CORTLAND ASC, LLC, CORTLAND SURGICAL CENTER | 461344196 - (NY) CORTLAND ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $2007.00 | 1497749436 - NEW JERSEY SURGERY CENTER LLC, NEW JERSEY SURGERY CENTER | 161666417 - (NJ) NEW JERSEY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $760.00 | 1366181778 - AXION SPINE OUTPATIENT SURGERY CENTER | 881709019 - (GA) AXION SPINE OUTPATIENT SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $825.00 | 1376269324 - THE SURGEON'S POINT SURGERY CENTER, LLC, THE SURGEON'S POINT AT CEDAR PARK | 301282509 - (TX) THE SURGEONS POINT SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $1910.00 | 1912199258 - SURGICARE SURGICAL ASSOCIATES OF RIDGEWOOD, LLC | 203728835 - (NJ) SURGICARE SURGICAL ASSOCIATES OF RIDGEWOOD LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $493.00 | 1104877976 - VICTOR R. MICHALAK, DBA COSMETIC SURGERY & DERMATOLOGY OF ISSAQUAH, INC. | 911521306 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $884.00 | 1780683797 - LOVELAND ENDOSCOPY CENTER, LLC, SKYLINE ENDOSCOPY CENTER | 421589159 - (CO) LOVELAND ENDOSCOPY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $2787.00 | 1710931860 - GRASS VALLEY SURGERY CENTER, LLC | 272185264 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $400.00 | 1225225592 - WESTERN CAROLINA ENDOSCOPY CENTER, LLC | 562593197 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $1714.00 | 1205809795 - OAKHURST ENDOSCOPY ASC LLC, OCEAN SURGICAL PAVILION, INC. | 223182653 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $1400.00 | 1396342481 - PIEDMONT ASC LLC | 851448653 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $637.00 | 1447234919 - GENGASTRO LLC, ENDOSCOPY CENTER FOR DIGESTIVE HEALTH | 562315623 - (IA) GENGASTRO LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $553.00 | 1881002343 - INNOVATIVE SURGERY CENTER, LLC | 471395981 - (MD) INNOVATIVE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43999 | $2349.00 | 1821642661 - STEAMBOAT SURGERY CENTER, LLC | 834367630 - (CO) STEAMBOAT SURGERY CENTER LLC | CO | 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 43999 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43999 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 43999 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 |
|---|---|---|
| 43999-CPT | High | Unlisted Procedure, Stomach Intestines |
| 44005-CPT | High | Enterolysis W Acute Bowel Obstruct |
| 44010-CPT | High | Duodenotomy |
| 44015-CPT | Low | Tube Or Needle Catheter Jejunostomy For Enteral Alimentation, Intraoperative, Any Method (List Separately In Addition To Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43999 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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