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CPT code 43405: Esophageal transection, ligation or stapling2026 Medicare rate & RVUs

Report this code for operative division of the esophagus using ligation or stapling, such as transection performed during surgical treatment of esophageal varices.

CMS RVU26DEffective Oct 1, 2026109 payment localities27 Medicare services in 2024

Medicare pays $1,402.17 for 43405 nationally in a facility.

Medicare rate · 43405

Esophageal transection, ligation or stapling

Office or facility?

Work RVUs
24.11
Total RVUs
41.98
Global days
090

National rate · 2026

$1,402.17

Facility setting, before claim adjustments.

See every locality for 43405 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 43405 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43405 covers

This code represents an operation that interrupts the esophagus by ligating or stapling it and dividing the organ. It may be used in surgical management of esophageal varices, where transection is performed as part of an operative strategy to control bleeding. A surgeon performs the procedure in an operating room, generally in a facility setting; Medicare recorded facility services for this code in 2024 and no office services.

Report the code when the operative documentation supports esophageal ligation or stapling with transection, rather than direct ligation of esophageal veins or repair of an injury. It has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and team-surgery payment 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 43405 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

43405 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,264.91
AlaskaUnavailable$1,739.40
ArizonaUnavailable$1,360.76
ArkansasUnavailable$1,248.27
Atlanta, GAUnavailable$1,451.64
Austin, TXUnavailable$1,403.53
Bakersfield, CAUnavailable$1,376.03
Baltimore area, MDUnavailable$1,491.88
Beaumont, TXUnavailable$1,352.30
Brazoria, TXUnavailable$1,360.46

43405 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
43405 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43405 rate is calculated

Each of 43405’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 · 43405

RVUs × geographic indexes × conversion factor

Office or facility?

Work24.11

24.11 RVUs× 1.000 GPCI

Practice expense11.80

11.80 RVUs× 1.000 GPCI

Malpractice6.07

6.07 RVUs× 1.000 GPCI

Adjusted RVUs

41.9800

Conversion factor

$33.4009

Medicare rate

$1,402.17

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 43405

43405 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43405

Esophageal transection, ligation or stapling

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 43405

Esophageal transection, ligation or stapling

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43405 without 51 · national facility

$1,402.17

Esophageal transection, ligation or stapling

43405-51 · Second procedure: 50%

$701.09

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%).

When to use modifier 51

43405 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43405

    Esophageal transection, ligation or stapling24.11 wRVU

    Not priced

  • 43400

    Varix ligation, thoracic or abdominal approach24.96 wRVU

    Not priced

  • 43410

    Esophageal repair, cervical approach16 wRVU

    Not priced

  • 43415

    Esophageal repair, thoracic or abdominal approach43.76 wRVU

    Not priced

How to choose

43400Varix ligationThoracic or abdominal approach
Choose 43400 for ligation of esophageal veins. Choose 43405 when the operation ligates or staples and transects the esophagus.
43410Esophageal repairCervical approach
43410 describes repair of an esophageal wound through a cervical approach; 43405 describes ligation or stapling with esophageal transection.
43415Esophageal repairThoracic or abdominal approach
43415 describes repair of an esophageal wound through a thoracic or abdominal approach. It is not the code for deliberate esophageal transection.

Codes related to 43405

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

Codes related to 43405
CodeHow it relatesNational office range
Used instead
43400Varix ligation, thoracic or abdominal approachDirect ligation of esophageal veins for variceal disease, without the esophageal transection described here.No office rate
43410Esophageal repair, cervical approachRepair of an esophageal wound through a cervical approach when the service is wound repair, not planned transection.No office rate
43415Esophageal repair, thoracic or abdominal approachRepair of an esophageal wound through a thoracic or abdominal approach, rather than planned transection.No office rate

43405 billing questions

How does this differ from 43400?

This code describes ligation or stapling with division of the esophagus. Code 43400 is for ligation of esophageal veins, without the esophageal transection described here.

Can this be reported with direct ligation of esophageal veins?

The procedures may be performed during the same operative session for variceal disease. Documentation should identify the distinct esophageal transection and the separate vein-ligation work.

Which global services are included?

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?

Medicare may pay for an assistant at surgery. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.

How are other procedures in the same session paid?

Medicare pays the highest-valued procedure in full and reduces the other procedures to 50% when multiple procedures are performed in the same session.

What operative documentation supports this code?

The operative report should establish that the esophagus was ligated or stapled and transected. A report describing only vein ligation or repair of an esophageal wound points to a different service.

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
RVUs for 43405PPRRVU2026_Oct_nonQPP.csv, line 5,244 (RVU26D)

Open CMS sourceHow we calculate rates

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