CPT code 43415: Esophageal repair, thoracic or abdominal approach2026 Medicare rate & RVUs in Michigan
Open repair of an esophageal wound through a thoracic or abdominal approach, typically reported for operative treatment of an injury or perforation.
CMS doesn’t publish an office rate for 43415 in Michigan.
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 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 Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | Unavailable | $2,646.34 |
| Rest of Michigan | Unavailable | $2,411.08 |
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.
How the rate is built · 43415
RVUs × geographic indexes × conversion factor
Work43.76
43.76 RVUs× 1.000 GPCI
Practice expense17.52
17.52 RVUs× 1.000 GPCI
Malpractice11.01
11.01 RVUs× 1.000 GPCI
Adjusted RVUs
72.2900
Conversion factor
$33.4009
Medicare rate
$2,414.55
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43415
43415 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43415
Esophageal repair, thoracic or abdominal approach
| 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 · 43415
Esophageal repair, thoracic or abdominal approach
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
43415 without 51 · national facility
$2,414.55
Esophageal repair, thoracic or abdominal approach
43415-51 · Second procedure: 50%
$1,207.28
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%).
43415 compared with similar codes
Compare codes · National
4 codes, side by side
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.
43415 billing questions
How does this differ from 43410?
43415 is for repair through a thoracic or abdominal approach. 43410 is the cervical-approach repair.
Can this be used to close an esophagostomy?
No. Closure of a surgically created esophagostomy is described by codes such as 43420 or 43425, depending on the approach.
What documentation supports reporting 43415?
The operative report should establish that an esophageal wound was repaired and document its location, the thoracic or abdominal approach, and the repair performed.
How does the global period affect billing?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Should modifier 50 be appended for an esophageal wound?
No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.
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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