CPT code 43328: Fundoplasty, thoracic approach2026 Medicare rate & RVUs

Medicare pays $1,061.15 for 43328 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 43328 covers

A surgeon approaches the esophagus through the chest and uses the upper stomach to create a wrap around the lower esophagus, reinforcing the barrier to reflux. This operation may be performed for gastroesophageal reflux requiring surgical treatment. It is generally done in a hospital operating room by a thoracic or foregut surgeon; the operative report should establish the thoracic route and describe the completed wrap.

Select this code for the thoracic approach, rather than the laparoscopic fundoplasty code when the operation is performed laparoscopically. Documentation should identify the indication, operative approach, and fundoplasty performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care for 90 days. When 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. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation. 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 43328 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

43328 rates by state

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

How the 43328 rate is calculated

Each of 43328’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 43328

43328 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

43328 compared with similar codes

How to choose

43327FundoplastyLaparoscopic approach

43327 identifies laparoscopic fundoplasty. Use 43328 for the thoracic approach.

43320Esophageal reconstructionStomach connection

Both concern esophagogastric fundoplasty, but 43328 is specific to the thoracic approach. Confirm the operative route before selecting between them.

43325Anastomosis revisionAbdominal approach

43325 covers a fundoplasty performed with repair of a paraesophageal hiatal hernia. Distinguish that combined hernia-repair service from thoracic fundoplasty alone.

43334Diaphragmatic hernia repairTransthoracic, without prosthesis

43334 describes transthoracic diaphragmatic hernia repair. Choose based on whether the documented operation is hernia repair or fundoplasty.

Codes related to 43328

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