CPT code 43337: Diaphragmatic hernia repair, thoracoabdominal approach with mesh2026 Medicare rate & RVUs in Massachusetts
Reports open repair of a non-neonatal diaphragmatic hernia through combined chest and abdominal access when mesh or another prosthesis reinforces the repair.
CMS doesn’t publish an office rate for 43337 in Massachusetts.
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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On this page 9 sections
What 43337 covers
This code represents open repair of a diaphragmatic hernia using an approach that enters both the chest and abdomen, with mesh or another prosthetic material used to reinforce the defect. The surgeon reduces herniated abdominal contents and repairs the diaphragm; the combined access may be selected for a defect that requires exposure from both cavities. The service is performed in an operating room, typically by a surgeon treating a complex diaphragmatic defect in a hospital setting.
Select this code when the operative report supports the thoracoabdominal route and documents placement of mesh or another prosthesis; a thoracoabdominal repair without prosthetic reinforcement is represented by a related code. The 90-day global period includes the day-before preoperative visit and 90 days of 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-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.
Where 43337 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | $1,525.80 |
| Rest of Massachusetts | Unavailable | $1,436.54 |
How the 43337 rate is calculated
Each of 43337’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 · 43337
RVUs × geographic indexes × conversion factor
Work26.96
26.96 RVUs× 1.000 GPCI
Practice expense9.70
9.70 RVUs× 1.000 GPCI
Malpractice6.78
6.78 RVUs× 1.000 GPCI
Adjusted RVUs
43.4400
Conversion factor
$33.4009
Medicare rate
$1,450.94
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43337
43337 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43337
Diaphragmatic hernia repair, thoracoabdominal approach with mesh
| 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 · 43337
Diaphragmatic hernia repair, thoracoabdominal approach with mesh
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
43337 without 51 · national facility
$1,450.94
Diaphragmatic hernia repair, thoracoabdominal approach with mesh
43337-51 · Second procedure: 50%
$725.47
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%).
43337 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43336Hernia repairThoracoabdominal, without mesh
- Both use thoracoabdominal access for diaphragmatic hernia repair. Choose 43337 when mesh or another prosthesis reinforces the repair; choose 43336 when it does not.
- 43335Hiatal hernia repairThoracic approach with mesh
- Both include prosthetic reinforcement, but 43335 uses a transthoracic approach. 43337 requires thoracoabdominal access.
- 43333Hernia repairTransabdominal, with mesh
- 43333 addresses paraesophageal hernia repair through an abdominal approach. 43337 is for diaphragmatic hernia repair through combined chest and abdominal access.
43337 billing questions
How is this code distinguished from 43336?
Both describe diaphragmatic hernia repair through thoracoabdominal access. Use 43337 when the repair includes mesh or another prosthetic material; 43336 represents the repair without that reinforcement.
When is a thoracoabdominal approach appropriate?
The operative report must support access through both the chest and abdomen for the diaphragmatic hernia repair. Do not select this code solely because the hernia is large or complex.
Can modifier 50 be reported?
No. The anatomy and service do not support a bilateral adjustment.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does payment change when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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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