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CPT code 43425: Fistula repair, esophageal opening2026 Medicare rate & RVUs

Reports operative repair of an esophageal fistula, such as a persistent abnormal connection requiring surgical closure by an esophageal surgeon.

CMS RVU26DEffective Oct 1, 2026109 payment localities24 Medicare services in 2024

Medicare pays $1,375.78 for 43425 nationally in a facility.

Medicare rate · 43425

Fistula repair, esophageal opening

Office or facility?

Work RVUs
24.41
Total RVUs
41.19
Global days
090

National rate · 2026

$1,375.78

Facility setting, before claim adjustments.

See every locality for 43425 →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 43425 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 43425 covers

This code describes an operation to close or repair an abnormal fistulous opening involving the esophagus. A thoracic or general surgeon typically performs the repair in an operating room, often in a hospital setting. The operative report should identify the fistula, its relationship to the esophagus, the surgical approach, and the repair performed. A persistent fistula after prior esophageal surgery is one clinical situation in which this type of repair may be considered.

Report the code when the documented operation is directed at an esophageal fistula; distinguish it from repair of an esophageal wound or closure of an esophagostomy. This major surgery code includes 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 multiple procedure reduction. Modifier 50 is inappropriate for this anatomy. An assistant at surgery may be paid; 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 43425 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

43425 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,242.15
AlaskaUnavailable$1,714.12
ArizonaUnavailable$1,335.16
ArkansasUnavailable$1,225.98
Atlanta, GAUnavailable$1,425.26
Austin, TXUnavailable$1,374.53
Bakersfield, CAUnavailable$1,344.88
Baltimore area, MDUnavailable$1,463.49
Beaumont, TXUnavailable$1,329.25
Brazoria, TXUnavailable$1,333.85

43425 rates by state

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

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Explore a state

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
43425 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 43425 rate is calculated

Each of 43425’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 · 43425

RVUs × geographic indexes × conversion factor

Office or facility?

Work24.41

24.41 RVUs× 1.000 GPCI

Practice expense10.62

10.62 RVUs× 1.000 GPCI

Malpractice6.16

6.16 RVUs× 1.000 GPCI

Adjusted RVUs

41.1900

Conversion factor

$33.4009

Medicare rate

$1,375.78

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

Payment rules and modifiers for 43425

43425 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43425

Fistula repair, esophageal opening

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 · 43425

Fistula repair, esophageal opening

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

43425 without 51 · national facility

$1,375.78

Fistula repair, esophageal opening

43425-51 · Second procedure: 50%

$687.89

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

43425 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43425

    Fistula repair, esophageal opening24.41 wRVU

    Not priced

  • 43420

    Esophageal repair, cervical approach16.36 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

43420Esophageal repairCervical approach
43420 is used to close an esophagostomy. Choose 43425 when the operative target is an esophageal fistula.
43410Esophageal repairCervical approach
43410 describes repair of an esophageal wound by a cervical approach. A fistula repair is described by 43425.
43415Esophageal repairThoracic or abdominal approach
43415 describes repair of an esophageal wound by a thoracic approach. Use 43425 for repair of an esophageal fistula.

Codes related to 43425

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

Codes related to 43425
CodeHow it relatesNational office range
Same family
43420Esophageal repair, cervical approachCloses an esophagostomy rather than repairing an esophageal fistula.No office rate
Used instead
43410Esophageal repair, cervical approachFor repair of an esophageal wound by a cervical approach.No office rate
43415Esophageal repair, thoracic or abdominal approachFor repair of an esophageal wound by a thoracic approach.No office rate
43499Esophageal procedure, unlistedUnlisted esophageal procedure code when no specific code describes the operation.No office rate

43425 billing questions

How is this code distinguished from 43420?

Use the operative target documented by the surgeon. Code 43425 is for repair of an esophageal fistula; 43420 is for closure of an esophagostomy.

Is this code used for an esophageal wound?

No. Codes 43410 and 43415 describe repair of an esophageal wound, with the approach distinguishing those codes. This code is for fistula repair.

Are related postoperative visits included?

Yes. 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 used for fistulas on both sides?

No. The anatomy and descriptor make modifier 50 inappropriate for this code.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard multiple procedure reduction.

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 43425PPRRVU2026_Oct_nonQPP.csv, line 5,249 (RVU26D)

Open CMS sourceHow we calculate rates

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