CPT code 43415: Esophageal repair, thoracic or abdominal approach2026 Medicare rate & RVUs in California

CMS doesn’t publish an office rate for 43415 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.

What 43415 covers

This code describes operative repair of an esophageal wound reached through the chest or abdomen. It may be used for a traumatic injury or an esophageal perforation requiring open surgical closure. A thoracic or general surgeon typically performs the repair in a hospital operating room; the approach documented in the operative report distinguishes it from cervical repair.

Report the code when the surgeon’s work addresses a wound in the esophagus, not closure of a surgically created esophagostomy. The operative report should identify the injury, its location, the approach, and the repair performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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% reduction. Assistant-at-surgery payment may be made; 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 43415 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

How the 43415 rate is calculated

Each of 43415’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 43415

43415 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

43415 compared with similar codes

How to choose

43410Esophageal repairCervical approach

Use 43410 for an esophageal wound repaired through a cervical approach; use 43415 for a thoracic or abdominal approach.

43420Esophageal repairCervical approach

43420 addresses closure of a surgically created esophagostomy through a cervical approach, not repair of an esophageal wound.

43425Fistula repairEsophageal opening

43425 is for closure of an esophagostomy through a thoracic or abdominal approach. 43415 repairs an esophageal wound using those approaches.

Codes related to 43415

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