CPT code 43497: Esophageal myotomy, transoral approach2026 Medicare rate & RVUs in Florida
Reports endoscopic division of lower esophageal muscle, commonly to treat achalasia or selected spastic esophageal motility disorders.
CMS doesn’t publish an office rate for 43497 in Florida.
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 43497 covers
This procedure, often called POEM, uses a transoral endoscope to create a tunnel within the esophageal wall and divide muscle at the lower esophageal sphincter and distal esophagus. It is performed for achalasia and selected spastic motility disorders. A surgeon or advanced therapeutic endoscopist typically performs it in a hospital operating room under general anesthesia; the procedure includes endoscopic access, the myotomy, and closure of the mucosal entry.
Report 43497 when the operative record supports a transoral endoscopic myotomy, rather than esophageal dilation or an open myotomy. Documentation should identify the approach and the muscle treated. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are 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 43497 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | Unavailable | $769.96 |
| Miami, FL | Unavailable | $819.62 |
| Rest of Florida | Unavailable | $738.77 |
How the 43497 rate is calculated
Each of 43497’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 · 43497
RVUs × geographic indexes × conversion factor
Work12.96
12.96 RVUs× 1.000 GPCI
Practice expense6.75
6.75 RVUs× 1.000 GPCI
Malpractice1.80
1.80 RVUs× 1.000 GPCI
Adjusted RVUs
21.5100
Conversion factor
$33.4009
Medicare rate
$718.45
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43497
43497 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43497
Esophageal myotomy, transoral 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 | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 43497
Esophageal myotomy, transoral 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
43497 without 51 · national facility
$718.45
Esophageal myotomy, transoral approach
43497-51 · Second procedure: 50%
$359.23
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%).
43497 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43249Esophageal dilationBalloon under 30 mm
- Use for endoscopic balloon dilation of the esophagus, not for cutting the lower esophageal muscle through a transoral tunnel.
- 43450Esophageal dilationUnguided sound or bougie
- This code describes esophageal dilation by sound or bougie; 43497 describes a transoral endoscopic myotomy.
- 43453Esophageal dilationBalloon with fluoroscopy
- This code describes esophageal dilation over a guide wire. Choose 43497 when the documented procedure divides lower esophageal muscle.
43497 billing questions
When should 43497 be chosen over an esophageal dilation code?
Use 43497 when the provider performs a transoral endoscopic myotomy by cutting lower esophageal muscle. Dilation enlarges the passage without performing that myotomy.
How does 43497 differ from 43450 and 43453?
43497 describes a transoral myotomy. 43450 and 43453 describe esophageal dilation; 43453 is performed over a guide wire.
Can a related endoscopy be reported in the same session?
When related endoscopies are performed together, CMS endoscopy family pricing applies. The operative documentation should support each reported service.
Does modifier 50 apply to 43497?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be paid for 43497?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
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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