How much does Medicare pay for CPT 43282?

Medicare allowed an average of $1367.30 per service and paid $1087.43 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5749.56, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43282?

Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope. It was billed 4,272 times to 4,258 Medicare beneficiaries by 226 providers in 2024.

Which specialty bills 43282 most?

General Surgery, with 3,079 services from 162 clinicians. Next are Physician Assistant, Thoracic Surgery, Nurse Practitioner.

CPT 43282

Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope

$1367.30Medicare-allowed amount per service, averaged across 4,272 services

Providers submitted

$5749.56

Asking price, not received

Medicare allowed

$1367.30

The fee schedule figure

Medicare paid

$1087.43

Balance is patient coinsurance

Providers submitted an average of $5749.56 for this code and Medicare allowed $1367.30 — 4.2× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $1087.43 (80%); the rest is the patient’s coinsurance and deductible.

Services: 4,272
Beneficiaries: 4,258
Providers billing it: 226
Total allowed: $5,841,106

What Medicare pays for CPT 43282

Across 4,272 services billed by 226 providers to 4,258 beneficiaries, Medicare allowed an average of $1367.30 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 43282

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	3,079	3,070	$1616.50	162
Physician Assistant	615	614	$230.36	35
Thoracic Surgery	322	319	$1710.29	18
Nurse Practitioner	163	162	$224.49	6
Cardiac Surgery	36	36	$1712.36	2
Gastroenterology	31	31	$1011.64	1
General Practice	14	14	$1664.20	1
Surgical Oncology	12	12	$1551.24	1

43282 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	478	$1261.62	$987.87	28
Florida	455	$1239.77	$909.06	23
California	335	$1501.71	$1148.79	20
Colorado	309	$1195.38	$919.99	11
Arizona	280	$1242.00	$958.74	16
Georgia	246	$1388.33	$1081.71	10
Missouri	240	$1116.83	$912.72	9
Pennsylvania	193	$1421.05	$1090.11	8
New York	171	$1586.12	$1054.11	10
Ohio	154	$1516.51	$1206.30	10
North Carolina	150	$1446.67	$1228.77	10
South Carolina	124	$1366.73	$1116.57	5
New Jersey	114	$1252.19	$889.18	6
Virginia	107	$1744.87	$1337.69	4
Maryland	88	$1746.98	$1257.42	5
Washington	80	$1689.90	$1298.03	4
Oklahoma	75	$1341.24	$1078.51	4
Illinois	72	$1531.21	$1039.93	4
Kentucky	61	$1672.64	$1332.35	4
Indiana	50	$1516.47	$1324.79	4
Massachusetts	46	$1714.56	$1342.15	2
Montana	45	$979.45	$737.54	2
Nebraska	40	$1095.74	$994.53	3
Alabama	39	$1095.40	$957.54	3
Nevada	35	$951.25	$731.13	2
Idaho	31	$1584.25	$1308.08	2
Vermont	29	$1565.32	$1330.73	1
Wisconsin	29	$1513.27	$1348.00	2
Connecticut	28	$1812.00	$1345.56	2
South Dakota	25	$1528.28	$1336.32	2
Tennessee	25	$1307.42	$1175.26	2
Mississippi	19	$1252.28	$924.84	1
New Mexico	17	$1814.16	$1347.69	1
Oregon	15	$1673.50	$1339.10	1
West Virginia	14	$1519.44	$1150.30	1
Delaware	14	$1721.39	$1348.71	1
Kansas	13	$1460.47	$1346.89	1
Louisiana	13	$1645.51	$1348.59	1
District of Columbia	13	$254.86	$105.59	1

Related codes

43239Biopsy of esophagus$167.49
43235Diagnostic exam of esophagus$145.31
43249Balloon dilation of esophagus$337.40
43248Insertion of guide wire$223.15
43264Removal of stone or debris from bile or pancreatic duct$135.60
43251Removal of polyps or growths of esophagus$419.64
43274Insertion of stent into pancreatic or bile duct$392.61
43259Ultrasound exam of esophagus$230.50
43242Ultrasound guided needle aspiration or biopsy of esophagus$249.98
43255Control of bleeding of esophagus$200.78
43237Ultrasound exam of esophagus$204.08
43246Insertion of stomach tube$194.27

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.