CPT code 43305: Esophageal repair, with fistula repair2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $945.23 for 43305 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43305 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 43305 covers

A surgeon repairs the esophagus and closes an associated fistula, commonly a tracheoesophageal communication. This may be performed for a congenital abnormal connection or another surgically treated esophageal-fistula condition. The operative report should identify the esophageal defect, the fistula repaired, and the surgical approach. This is an operative service, generally performed in a hospital or other surgical facility.

Choose this code when the documented operation includes both esophageal repair and fistula closure; use the full code descriptor and operative details to distinguish it from related esophageal repair codes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 43305

Across 109 of 109 payment localities, the facility rate for 43305 runs from $864.01 in Arkansas to $1,217.06 in Alaska. Puerto Rico pays $945.23. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43305 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 43305 in every payment locality

How the 43305 rate is calculated

Each of 43305’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 43305

43305 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

Codes related to 43305

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 43305 has changed in Puerto Rico

Price 43305 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates