CPT code 43312: Esophageal repair, thoracic approach with fistula2026 Medicare rate & RVUs

Medicare pays $1,478.66 for 43312 nationally in a facility.

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

What 43312 covers

This operation repairs an esophageal defect through a thoracic approach and closes a communication between the esophagus and trachea. It may be used for a tracheoesophageal fistula associated with congenital disease or one acquired after injury, surgery, or prolonged airway instrumentation. A thoracic or general surgeon typically performs the repair in an operating room, often with anesthesia and other surgical support.

Select this code when the operative report documents both the thoracic approach and repair of the fistula, not merely an esophageal repair without fistula closure. Documentation should identify the fistula and describe its closure as part of the operation. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require 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.

Where 43312 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43312 rates by state

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

How the 43312 rate is calculated

Each of 43312’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 43312

43312 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

43312 compared with similar codes

How to choose

43310Esophageal repairThoracic approach, no fistula

Use 43312 when the thoracic operation also repairs a tracheoesophageal fistula; 43310 describes thoracic esophageal repair without that fistula repair.

43305Esophageal repairWith fistula repair

Both include fistula repair, but 43305 uses a cervical approach. Choose based on the approach documented for the operation.

43300Esophageal repairCervical approach, no fistula repair

43300 is a cervical esophageal repair without fistula repair. This code involves a thoracic approach and includes fistula closure.

Codes related to 43312

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

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