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

In Puerto Rico, Medicare pays $2,415.47 for 43415 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43415 nationwide

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.

How Puerto Rico compares for 43415

Across 109 of 109 payment localities, the facility rate for 43415 runs from $2,135.49 in Wisconsin to $3,018.28 in Alaska. Puerto Rico pays $2,415.47. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43415 rates by state

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

See 43415 in every payment locality

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

Codes related to 43415

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

How 43415 has changed in Puerto Rico

Price 43415 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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