HCPCS C7543 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 | • Outpatient PPS • Miscellaneous Surgical Procedures |
| Complexity Level | Moderate |
National average reimbursement for HCPCS C7543 by major payers:
$329.52
$N/A
$8,124.78
$N/A
| 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 HCPCS C7543 | ||||||
United | C7543 | $1508.00 | 1801849104 - WOMEN & CHILDRENS HOSPITAL LLC, LAKE AREA MEDICAL CENTER | 720411322 - (LA) CHRISTUS HEALTH SOUTHWESTERN LOUISIANA | LA | General Acute Care Hospital (282N00000X) |
United | C7543 | $601.00 | 1497090740 - OLOL PONTCHARTRAIN SURGERY CENTER, LLC, OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER | 461379031 - (LA) OLOL PONTCHARTRAIN SURGERY CENTE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7543 | $300.00 | 1548233794 - METAIRIE OPHTHALMOLOGY ASC LLC, AMBULATORY EYE SURGERY CENTER OF LOUISIANA | 621822003 - (LA) THE METAIRIE OPHTHALMOLOGY ASC, LLC DBA AMBULATORY EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7543 | $2064.00 | 1881665164 - CLHG-LEESVILLE, BYRD REGIONAL HOSPITAL | 824337635 | LA | General Acute Care Hospital (282N00000X) |
United | C7543 | $4765.00 | 1811973100 - OCHSNER CLINIC FOUNDATION, OCHSNER MEDICAL CENTER ACUTE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | General Acute Care Hospital (282N00000X) |
United | C7543 | $425.00 | 1023542339 - BATON ROUGE VASCULAR ACCESS ASC LLC | 814685509 - (LA) BATON ROUGE VASCULAR ACCESS ASC LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7543 | $341.00 | 1700874062 - RIVERSIDE MEDICAL CENTER, RIVERSIDE MEDICAL CENTER | 720629905 - (LA) RIVERSIDE MEDICAL CENTER | LA | Critical Access Hospital (282NC0060X) |
United | C7543 | $1147.00 | 1093876997 - PHC-MORGAN CITY LP, TECHE REGIONAL MEDICAL CENTER | 842237042 | LA | Rural Acute Care Hospital (282NR1301X) |
United | C7543 | $5777.00 | 1396394961 - CLHG-ACADIAN, LLC, ACADIAN MEDICAL CENTER | 825359949 | LA | General Acute Care Hospital (282N00000X) |
United | C7543 | $3072.00 | 1487706214 - IASIS GLENWOOD REGIONAL MEDICAL CENTER LP | 205249827 - (LA) IASIS GLENWOOD REGIONAL MEDICAL CENTER LP | LA | General Acute Care Hospital (282N00000X) |
United | C7543 | $338.00 | 1972770022 - OUTPATIENT EYE SURGERY CENTER | 721098835 - (LA) OUTPATIENT EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7543 | $806.00 | 1447377767 - HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF VERMILION, ABROM KAPLAN MEMORIAL HOSPITAL | 472540179 - (LA) KAPLAN GENERAL HOSPITAL INC | LA | Critical Access Hospital (282NC0060X) |
United | C7543 | $363.00 | 1134126659 - CALDWELL MEMORIAL HOSPITAL INC | 720878037 - (LA) CALDWELL MEMORIAL HOSPITAL, INC. | LA | General Acute Care Hospital (282N00000X) |
United | C7543 | $540.00 | 1750469789 - ORTHOPEDIC SURGERY CENTER LLC, ORTHOPEDIC SURGERY CENTER | 364568309 - (LA) ORTHOPEDIC SURGERY CENTER, LLC. | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7543 | $5729.00 | 1043533706 - OCHSNER MEDICAL CENTER, OCHSNER MEDICAL CENTER - NORTHSHORE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | General Acute Care Hospital (282N00000X) |
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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HCPCS C7543 vs. Other Miscellaneous Surgical Procedures Codes
The HCPCS C7543 code is part of the Outpatient PPS services used for Miscellaneous Surgical Procedures. 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 HCPCS C7543 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 |
|---|---|---|
| C7542-HCPCS | Moderate | Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
| C7543-HCPCS | Moderate | Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
| C7544-HCPCS | Moderate | Endoscopic retrograde cholangiopancreatography (ercp) with removal of calculi/debris from biliary/pancreatic duct(s), with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C7543. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C7543 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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