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Billing code 43361: GI repairMedicare rate & RVUs

Reports major operative repair in the esophageal gastrointestinal surgery family, with selection based on the specific repair performed and operative circumstances.

CMS RVU26DEffective Oct 1, 2026109 payment localities27 Medicare services in 2024

Medicare pays $2,507.74 for 43361 nationally in a facility.

Medicare rate · 43361

GI repair

Swap in your local Medicare rate.

Work RVUs
44.54
Total RVUs
75.08
Global days
090

National rate · 2026

$2,507.74

Facility setting, before claim adjustments.

See every locality for 43361 → · 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 43361 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 43361 covers

This code represents a major surgical repair in the esophageal gastrointestinal surgery family. A surgeon typically performs the service in a hospital operating room to correct an operative defect or injury involving the gastrointestinal tract. The operative report should identify the anatomy repaired, the problem addressed, and the repair actually performed; the code should reflect that specific procedure rather than a general description of gastrointestinal surgery.

Report the code for the documented service, distinguishing it from other esophageal repairs by the procedure details and any associated condition or reconstruction. CMS assigns a 90-day global period, which 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 50% reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made; 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 43361 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

43361 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,257.00
Alaska*Unavailable$3,112.90
ArizonaUnavailable$2,431.05
ArkansasUnavailable$2,226.72
AtlantaUnavailable$2,602.30
AustinUnavailable$2,501.28
BakersfieldUnavailable$2,439.71
Baltimore/Surr. CntysUnavailable$2,671.41
BeaumontUnavailable$2,423.51
BrazoriaUnavailable$2,426.31

43361 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
43361 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 43361 rate is calculated

Each of 43361’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 · 43361

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 44.54Practice expense 18.60Malpractice 11.94

75.0800 adjusted RVUs×$33.4009 conversion factor=$2,507.74

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

Payment rules and modifiers for 43361

43361 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43361

GI 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 · 43361

GI 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

43361 without 51 · national facility

$2,507.74

GI repair

43361-51 · Second procedure: 50%

$1,253.87

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

43361 compared with similar codes

Compare codes

43361 vs 43300 vs 43305 vs 43360: national Medicare rates

Swap in your local Medicare rate.

  • 43361
    GI repair · 44.54 wRVU
    —
  • 43300
    Esophageal repair · 9.1 wRVU
    —
  • 43305
    Esophageal repair · 17.65 wRVU
    —
  • 43360
    GI repair · 39.11 wRVU
    —

How to choose

43300Esophageal repair
Both are esophageal repair-family codes. Compare the documented repair and operative details rather than choosing by the general term repair alone.
43305Esophageal repair
This related code is associated with repair involving a fistula. Use the code that matches whether the documented service includes that condition.
43360GI repair
This neighboring code also has a gastrointestinal repair descriptor. Distinguish the codes using the specific procedure documented in the operative report.

Codes related to 43361

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

Codes related to 43361
CodeHow it relatesNational office range
Same family
43360GI repairAdjacent gastrointestinal repair code; select based on the procedure documented.No office rate
43300Esophageal repairRelated esophageal repair code for a distinct documented repair.No office rate
43305Esophageal repairEsophageal repair code associated with fistula repair.No office rate
43310Esophageal repairRelated esophageal repair code; distinguish by the operative service performed.No office rate
43312Esophageal repairEsophageal repair code associated with fistula repair.No office rate

43361 billing questions

How should this code be distinguished from other esophageal repair codes?

Use the code that matches the specific repair documented in the operative report. The anatomy, operative objective, and any associated fistula or reconstruction help distinguish related esophageal procedures.

Are related postoperative visits separately reported?

Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.

How does the multiple-procedure rule affect payment?

When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.

Can modifier 50 be used?

No. CMS identifies bilateral adjustment as inappropriate for this code.

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.

What operative documentation supports reporting this code?

Document the gastrointestinal anatomy treated, the condition or defect addressed, and the repair performed. The operative details should support choosing this code over other esophageal repair procedures.

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 43361PPRRVU2026_Oct_nonQPP.csv, line 5,242 (RVU26D)

Open CMS sourceHow we calculate rates

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