CPT 43107

What could change this amount? Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

Service location and setting · Participation and payment shares

How this amount is computed Copy link

CPT 43107 has a work RVU of 44.18, a non-facility practice expense RVU of 21.57, a facility practice expense RVU of 21.57 and a malpractice RVU of 9.87—for total non-facility RVUs of 75.62 and total facility RVUs of 75.62 in the Q1 2013 release.

amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead—higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.

Payment review for 43107 Copy link

Four published payment rules can change what 43107 allows on a claim: facility-only practice-expense pricing, the 90-day global package, the standard multiple-procedure reduction and assistant-at-surgery payment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Global period: what 43107's fee already covers Copy link

Major surgery. The fee covers the day before surgery, the day of surgery, and the 90 days after it. Related follow-up care inside that window is not billed separately.

Billing a related follow-up visit inside the 90-day window is the most common way this code gets denied—the payment for that care is already inside the 43107 fee.

A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.

Billing policy Copy link

What 43107's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.

Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link

National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

These apply standard MPFS percentages—assistant surgeon 16%, co-surgeon 62.5%, bilateral 150%—to the national non-facility amount above, and require both the RVU inputs and the applicable payment rule as evidence. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator pays it only when supporting documentation of medical necessity is submitted—an unpaid claim without that documentation is not an underpayment.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 43107.

See every current NCCI pair for 43107 →

Allowed amount, program payment, and patient share Copy link

These figures use the same national baseline, with different participation and payment assumptions.

National Q1 2013 figures at GPCI 1.000. Adjust for your locality and sequestration, or expand the explanations below for each figure in full.

Common payment questions Copy link

Rate history by release Copy link

National non-facility amount for 43107 across quarterly releases. +45.9% increase since Q1 2013 · high $3,124.28 in Q1 2020

Contracted rate: % of Medicare Copy link

Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 43107 pays at that rate—$1,890.56 is 100%.

We want to build this: store your multipliers once, and every code page shows your rate instead of Medicare's. Tell us if you'd use it →

See how to find your contract's actual percentage.

How often 43107 is billed Copy link

Across Original Medicare in CY2024, 43107 ranked #4,585 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2013 fee schedule above.