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Billing code 43335: Hiatal hernia repairMedicare rate & RVUs

Reports transthoracic repair of a paraesophageal hiatal hernia using mesh, including fundoplication when performed as part of the repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities42 Medicare services in 2024

Medicare pays $1,252.87 for 43335 nationally in a facility.

Medicare rate · 43335

Hiatal hernia repair

Swap in your local Medicare rate.

Work RVUs
23.37
Total RVUs
37.51
Global days
090

National rate · 2026

$1,252.87

Facility setting, before claim adjustments.

See every locality for 43335 → · 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 43335 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 43335 covers

This code describes repair of a paraesophageal hiatal hernia through a thoracic approach with mesh reinforcement; fundoplication is included when performed as part of the repair. A thoracic or general surgeon typically performs the operation in a hospital operating room, often for a large or complex hernia requiring access through the chest. The operative report should establish the hernia being repaired, the transthoracic route, and mesh use.

Select this code for the thoracic approach with mesh, rather than the corresponding thoracic repair without mesh or an abdominal approach. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, CMS pays the highest-valued procedure in full and others at 50%. Report this as a single repair, not with modifier 50. 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 43335 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

43335 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,133.14
Alaska*Unavailable$1,572.91
ArizonaUnavailable$1,216.03
ArkansasUnavailable$1,118.71
AtlantaUnavailable$1,299.10
AustinUnavailable$1,248.04
BakersfieldUnavailable$1,217.39
Baltimore/Surr. CntysUnavailable$1,332.04
BeaumontUnavailable$1,214.09
BrazoriaUnavailable$1,213.42

43335 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
43335 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 43335 rate is calculated

Each of 43335’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 · 43335

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 23.37Practice expense 8.26Malpractice 5.88

37.5100 adjusted RVUs×$33.4009 conversion factor=$1,252.87

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

Payment rules and modifiers for 43335

43335 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43335

Hiatal hernia 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 · 43335

Hiatal hernia 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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

43335 without 51 · national facility

$1,252.87

Hiatal hernia repair

43335-51 · Second procedure: 50%

$626.44

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

43335 compared with similar codes

Compare codes

43335 vs 43334 vs 43332 vs 43333: national Medicare rates

Swap in your local Medicare rate.

  • 43335
    Hiatal hernia repair · 23.37 wRVU
    —
  • 43334
    Diaphragmatic hernia repair · 21.57 wRVU
    —
  • 43332
    Hiatal hernia repair · 19.13 wRVU
    —
  • 43333
    Hernia repair · 20.92 wRVU
    —

How to choose

43334Diaphragmatic hernia repair
Both use a transthoracic approach for paraesophageal hernia repair. Choose 43335 when mesh is used and 43334 when it is not.
43332Hiatal hernia repair
This code is for the abdominal approach without mesh. The transthoracic approach with mesh is reported with 43335.
43333Hernia repair
This code is for abdominal-approach repair with mesh. The approach, not mesh use alone, distinguishes it from 43335.

Codes related to 43335

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

Codes related to 43335
CodeHow it relatesNational office range
Same family
43334Diaphragmatic hernia repairTransthoracic paraesophageal hernia repair without mesh.No office rate
Used instead
43332Hiatal hernia repairAbdominal-approach paraesophageal hernia repair without mesh.No office rate
43333Hernia repairAbdominal-approach paraesophageal hernia repair with mesh.No office rate

43335 billing questions

How does this differ from 43334?

Both describe transthoracic paraesophageal hernia repair; 43335 includes mesh, while 43334 is the corresponding repair without mesh. The operative report should support which was performed.

When should the abdominal-approach codes be considered?

Use the abdominal-approach family when the repair is performed through the abdomen. Codes 43332 and 43333 distinguish the abdominal approach without and with mesh, respectively.

Is fundoplication separately reported with this repair?

Fundoplication is included when performed as part of the paraesophageal hernia repair. The operative documentation should describe the repair and any fundoplication performed.

Can modifier 50 be used?

No. CMS identifies bilateral adjustment as inappropriate for this descriptor and anatomy; report the repair as a single procedure rather than appending modifier 50.

What postoperative care is included?

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

How are assistant and co-surgeon services handled?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is 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
RVUs for 43335PPRRVU2026_Oct_nonQPP.csv, line 5,233 (RVU26D)

Open CMS sourceHow we calculate rates

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