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Billing code 43210: Endoscopic fundoplastyMedicare rate & RVUs

Reports endoscopic creation of an antireflux valve at the esophagogastric junction for selected patients undergoing treatment for gastroesophageal reflux disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities181 Medicare services in 2024

Medicare pays $379.43 for 43210 nationally in a facility.

Medicare rate · 43210

Endoscopic fundoplasty

Swap in your local Medicare rate.

Work RVUs
7.56
Total RVUs
11.36
Global days
000

National rate · 2026

$379.43

Facility setting, before claim adjustments.

See every locality for 43210 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 43210 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 43210 covers

This therapeutic upper endoscopy creates an antireflux valve at the junction of the esophagus and stomach using an endoscopic fastening device. It is commonly performed as transoral incisionless fundoplication for selected patients with gastroesophageal reflux disease. A gastroenterologist or foregut surgeon typically performs it in a hospital or ambulatory endoscopy setting. The endoscope also permits evaluation of the upper gastrointestinal tract, including the duodenum when examined; the defining service is the fundoplasty, not diagnostic inspection alone.

Report the code when the endoscopic fundoplasty is actually performed, and document the indication, relevant anatomy and findings, and completion of the valve-forming work. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate for this procedure at the single esophagogastric junction. Medicare does not pay an assistant at surgery for this code; 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 43210 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

43210 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$352.22
Alaska*Unavailable$495.05
ArizonaUnavailable$371.35
ArkansasUnavailable$348.90
AtlantaUnavailable$389.02
AustinUnavailable$380.98
BakersfieldUnavailable$378.52
Baltimore/Surr. CntysUnavailable$398.77
BeaumontUnavailable$368.71
BrazoriaUnavailable$372.56

43210 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
43210 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 43210 rate is calculated

Each of 43210’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 · 43210

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.56Practice expense 2.70Malpractice 1.10

11.3600 adjusted RVUs×$33.4009 conversion factor=$379.43

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 43210

The CMS indicators that decide how 43210 is paid alongside other services.

CMS payment indicators · 43210

Endoscopic fundoplasty

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43210 without 51 · national facility

$379.43

Endoscopic fundoplasty

43210-51 · Second procedure: 50%

$189.72

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

43210 compared with similar codes

Compare codes

43210 vs 43235 vs 43280 vs 43281: national Medicare rates

Swap in your local Medicare rate.

  • 43210
    Endoscopic fundoplasty · 7.56 wRVU
    —
  • 43235
    Upper GI endoscopy · 2.04 wRVU
    $322.65
  • 43280
    Fundoplasty · 17.65 wRVU
    —
  • 43281
    Hernia repair · 25.94 wRVU
    —

How to choose

43235Upper GI endoscopy
43235 describes diagnostic upper endoscopy. Choose 43210 when the endoscopic fundoplasty is performed; inspection alone does not support it.
43280Fundoplasty
43280 is a laparoscopic surgical fundoplasty, while 43210 is an endoscopic transoral fundoplasty. Select according to the approach actually performed.
43281Hernia repair
43281 reports laparoscopic repair of a paraesophageal hernia. It is not a substitute for the endoscopic antireflux fundoplasty reported with 43210.

Codes related to 43210

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

Codes related to 43210
CodeHow it relatesNational office range
Used instead
43280FundoplastyLaparoscopic fundoplasty is the surgical alternative to this transoral endoscopic approach.No office rate
43235Upper GI endoscopyUse for diagnostic upper endoscopy when fundoplasty is not performed.$284.01–$435.38
Often billed with
43281Hernia repairMay accompany this service when a separate laparoscopic paraesophageal hernia repair is performed.No office rate

43210 billing questions

How does this differ from a diagnostic EGD?

This code reports therapeutic endoscopic fundoplasty to create an antireflux valve. A diagnostic EGD code is appropriate when the examination is performed without that fundoplasty.

Can a diagnostic EGD be reported separately on the same session?

The inspection that is part of the fundoplasty is included in this service. Do not separately report a diagnostic EGD for that same examination.

Can modifier 50 be used?

No. The procedure treats the esophagogastric junction, and CMS identifies bilateral adjustment as inappropriate for this code.

Can an assistant or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

What is included in the 0-day global period?

Same-day preoperative and postoperative care is included. The global period is zero days.

What if another related endoscopy is performed in the same session?

CMS endoscopy-family pricing applies when related endoscopies are performed together. Document each service performed and its findings.

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 43210PPRRVU2026_Oct_nonQPP.csv, line 5,147 (RVU26D)

Open CMS sourceHow we calculate rates

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