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See a sample rate comparisonCPT 43999 Fee Schedule
Last Verified: October 2026
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.
Unlisted Procedure Stomach, Unlisted Procedure Stomach
| 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 | 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43999 |
| Medicaid Fee Schedule | $885.17 median of the 3 states in the free preview · View Medicaid rates for 43999 |
National average reimbursement for CPT 43999 by major payers:
$1,221.04
$152.15
$3,547.30
$1,172.62
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CPT 43999
5 of 25 sample ratesHigher to lower in this preview
Grass Valley Surgery Center, LLC
$2,787.00Published rateOakhurst Endoscopy Asc LLC, Ocean Surgical Pavilion, Inc.
$1,714.00Published rateRegency Surgery Center, LLC
Regency Surgery Center LLC
$788.00Published rateGreenbrier Clinic Surgery Center
$567.00Published rateGreen Surgery Center LLC
$393.00Published rate
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See a sample payer proposalCPT 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, Unlisted Procedure Stomach |
| 44005-CPT | High | Enterolysis (Freeing Of Intestin Adhesion) (Sepa Proc), Enterolysis (Freeing Of Intestinal Adhesion) (Separate Procedure) |
| 44010-CPT | High | Intestine Exam And Surgery, Surgery To Explore The Intestines. The Procedure May Remove A Sample Of Tissue For Testing (Biopsy) Or Remove A Foreign Object. |
| 44015-CPT | Low | Tube Or Needle Catheter Jejuno, Tube Or Needle Catheter Jejunostomy For Enteralalimentation 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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