CPT code 43405: Esophageal transection, ligation or stapling2026 Medicare rate & RVUs in California
Report this code for operative division of the esophagus using ligation or stapling, such as transection performed during surgical treatment of esophageal varices.
CMS doesn’t publish an office rate for 43405 in California.
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 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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $1,376.03 |
| Chico, CA | Unavailable | $1,359.62 |
| El Centro, CA | Unavailable | $1,360.64 |
| Fresno, CA | Unavailable | $1,359.62 |
| Hanford, CA | Unavailable | $1,359.62 |
| Los Angeles, CA | Unavailable | $1,439.19 |
| Madera, CA | Unavailable | $1,359.62 |
| Marin County, CA | Unavailable | $1,530.58 |
| Merced, CA | Unavailable | $1,359.62 |
| Modesto, CA | Unavailable | $1,359.62 |
| Napa, CA | Unavailable | $1,478.49 |
| Oxnard, CA | Unavailable | $1,420.02 |
| Redding, CA | Unavailable | $1,359.62 |
| Rest of California | Unavailable | $1,359.62 |
| Riverside, CA | Unavailable | $1,424.70 |
| Sacramento, CA | Unavailable | $1,401.33 |
| Salinas, CA | Unavailable | $1,395.73 |
| San Benito County, CA | Unavailable | $1,570.89 |
| San Diego, CA | Unavailable | $1,410.72 |
| San Francisco, CA | Unavailable | $1,523.69 |
| San Luis Obispo, CA | Unavailable | $1,376.57 |
| Santa Clara County, CA | Unavailable | $1,542.70 |
| Santa Cruz, CA | Unavailable | $1,409.75 |
| Santa Maria, CA | Unavailable | $1,396.07 |
| Santa Rosa, CA | Unavailable | $1,422.12 |
| Stockton, CA | Unavailable | $1,359.62 |
| Vallejo, CA | Unavailable | $1,468.55 |
| Visalia, CA | Unavailable | $1,359.62 |
| Yuba City, CA | Unavailable | $1,359.62 |
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
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
| 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 · 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.
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%).
43405 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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