CPT code 43320: Esophageal reconstruction, stomach connection2026 Medicare rate & RVUs in Guam
Reports surgical reconstruction connecting the esophagus to the stomach, commonly when the stomach serves as a conduit after esophageal resection.
CMS doesn’t publish an office rate for 43320 in Guam.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 43320 covers
A surgeon creates a connection between the esophagus and stomach, often using the stomach to restore continuity after part of the esophagus has been removed. The operation is performed in a surgical setting by a thoracic or gastrointestinal surgeon. A pyloroplasty may also be performed as part of the reconstruction and is included in this service.
Report this code when the operative record supports creation of the esophagus-to-stomach connection; document the reconstruction, the anatomy involved, and any associated pyloroplasty. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. If multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this single reconstruction. 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.
43320 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $1,269.84 |
How the 43320 rate is calculated
Each of 43320’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.
How the rate is built · 43320
RVUs × geographic indexes × conversion factor
Work22.73
22.73 RVUs× 1.000 GPCI
Practice expense10.35
10.35 RVUs× 1.000 GPCI
Malpractice6.08
6.08 RVUs× 1.000 GPCI
Adjusted RVUs
39.1600
Conversion factor
$33.4009
Medicare rate
$1,307.98
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43320
43320 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43320
Esophageal reconstruction, stomach connection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43320
Esophageal reconstruction, stomach connection
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43320 without 51 · national facility
$1,307.98
Esophageal reconstruction, stomach connection
43320-51 · Second procedure: 50%
$653.99
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43320 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43325Anastomosis revisionAbdominal approach
- This code creates an esophagus-to-stomach connection. Code 43325 describes revision of an existing esophagogastric anastomosis.
- 43340Esophageal reconstructionIntestinal connection
- Choose 43320 when the esophagus is connected to the stomach; 43340 is for connection to intestine.
- 43327FundoplastyLaparoscopic approach
- Code 43327 describes laparoscopic esophagogastric fundoplasty, an antireflux operation rather than reconstruction of esophageal continuity.
43320 billing questions
When should this code be selected instead of an esophagoenterostomy code?
Use this code when the reconstruction connects the esophagus to the stomach. Esophagoenterostomy codes describe a connection to intestine instead.
Is pyloroplasty separately reported with this reconstruction?
A pyloroplasty performed as part of this reconstruction is included in the service.
Does modifier 50 apply?
No. The procedure creates one esophagus-to-stomach connection, not a bilateral service.
What documentation supports reporting this code?
The operative report should identify the esophagus-to-stomach reconstruction, the anatomy connected, and the role of the stomach in restoring continuity.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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
Show the CMS file lines behind this rate
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