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Billing code 43305: Esophageal repairMedicare rate & RVUs

Reports operative repair of the esophagus together with closure of an associated fistula, such as a tracheoesophageal connection, during the same procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities69 Medicare services in 2024

Medicare pays $943.58 for 43305 nationally in a facility.

Medicare rate · 43305

Esophageal repair

Work RVUs
17.65
Total RVUs
28.25
Global days
090

National rate · 2026

$943.58

Facility setting, before claim adjustments.

See every locality for 43305 →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 43305 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 43305 covers

A surgeon repairs the esophagus and closes an associated fistula, commonly a tracheoesophageal communication. This may be performed for a congenital abnormal connection or another surgically treated esophageal-fistula condition. The operative report should identify the esophageal defect, the fistula repaired, and the surgical approach. This is an operative service, generally performed in a hospital or other surgical facility.

Choose this code when the documented operation includes both esophageal repair and fistula closure; use the full code descriptor and operative details to distinguish it from related esophageal repair codes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 43305 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

43305 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$872.69
Alaska*Unavailable$1,217.06
ArizonaUnavailable$922.86
ArkansasUnavailable$864.01
AtlantaUnavailable$966.95
AustinUnavailable$950.47
BakersfieldUnavailable$946.80
Baltimore/Surr. CntysUnavailable$992.99
BeaumontUnavailable$913.35
BrazoriaUnavailable$926.92

43305 rates by state

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

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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
43305 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 43305 rate is calculated

Each of 43305’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 · 43305

RVUs × geographic indexes × conversion factor

Work17.65

17.65 RVUs× 1.000 GPCI

Practice expense8.02

8.02 RVUs× 1.000 GPCI

Malpractice2.58

2.58 RVUs× 1.000 GPCI

Adjusted RVUs

28.2500

Conversion factor

$33.4009

Medicare rate

$943.58

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

Payment rules and modifiers for 43305

43305 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43305

Esophageal repair

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 · 43305

Esophageal repair

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

43305 without 51 · national facility

$943.58

Esophageal repair

43305-51 · Second procedure: 50%

$471.79

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

43305 compared with similar codes

Compare codes · National

4 codes, side by side

  • 43305

    Esophageal repair17.65 wRVU

    Not priced

  • 43312

    Esophageal repair28.52 wRVU

    Not priced

  • 43300

    Esophageal repair9.1 wRVU

    Not priced

  • 43313

    Esophageal repair47.24 wRVU

    Not priced

How to choose

43312Esophageal repair
Both codes involve esophageal repair with fistula closure. Use the complete descriptors and operative report to identify which code matches the documented procedure and approach.
43300Esophageal repair
This is a nearby esophageal repair code. Check whether the operation includes fistula closure and compare the full descriptor before selecting between the codes.
43313Esophageal repair
This code describes congenital esophagoplasty. Choose it when that congenital esophageal reconstruction procedure, rather than the repair represented by 43305, is documented.

Codes related to 43305

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

Codes related to 43305
CodeHow it relatesNational office range
Same family
43312Esophageal repairRelated esophageal repair with fistula closure; distinguish using the full descriptor and operative approach.No office rate
Used instead
43300Esophageal repairNearby esophageal repair code; compare its full descriptor when the operation does not include fistula repair.No office rate
43310Esophageal repairAnother nearby esophageal repair code; use the complete descriptor to match the documented procedure.No office rate
43313Esophageal repairCongenital esophagoplasty code for a different procedure description.No office rate
43314Tracheoesophageal repairCongenital tracheoesophagoplasty code; compare the specific operation documented.No office rate

43305 billing questions

How is this code distinguished from 43312?

Both descriptors concern esophageal repair with fistula repair. Check the complete code descriptors and operative report for the distinction, including the documented surgical approach.

Can the fistula closure be billed separately?

When fistula closure is part of the esophageal repair reported with this code, it is included in that service. The operative report should support both elements of the coded procedure.

Should modifier 50 be appended for a fistula involving paired structures?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.

What postoperative care is included in the global period?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

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 43305PPRRVU2026_Oct_nonQPP.csv, line 5,218 (RVU26D)

Open CMS sourceHow we calculate rates

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