No office rate
Use 43312 when the thoracic operation also repairs a tracheoesophageal fistula; 43310 describes thoracic esophageal repair without that fistula repair.
On this page
CMS RVU26D · Effective 2026-10-01
43312 in Madera
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1410.68
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Esophageal surgery
About 43312: Thoracic esophageal repair with fistula closure
Reports open thoracic repair of an esophageal defect when the operation also closes a tracheoesophageal fistula.
This operation repairs an esophageal defect through a thoracic approach and closes a communication between the esophagus and trachea. It may be used for a tracheoesophageal fistula associated with congenital disease or one acquired after injury, surgery, or prolonged airway instrumentation. A thoracic or general surgeon typically performs the repair in an operating room, often with anesthesia and other surgical support.
Select this code when the operative report documents both the thoracic approach and repair of the fistula, not merely an esophageal repair without fistula closure. Documentation should identify the fistula and describe its closure as part of the operation. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures 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. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 43312
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU28.52 · 64%
- Practice expense (office) RVU8.55 · 19%
- Malpractice RVU7.20 · 16%
16
Medicare services in 2024 · #6038 by national volume
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.
43312 compared with similar codes
Office rates for Madera, from the same CMS release.
No office rate
Both include fistula repair, but 43305 uses a cervical approach. Choose based on the approach documented for the operation.
No office rate
43300 is a cervical esophageal repair without fistula repair. This code involves a thoracic approach and includes fistula closure.
The same code, a different location
How does Madera compare?
43312 across payment areas
Same release and payment basis · bars start at $0
Madera · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Merced
California · 43312
Office
Unavailable
Facility
$1410.68
No comparable office rate is available.
Modesto
California · 43312
Office
Unavailable
Facility
$1410.68
No comparable office rate is available.
Napa
California · 43312
Office
Unavailable
Facility
$1511.17
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 43312
Office
Unavailable
Facility
$1466.64
No comparable office rate is available.
Redding
California · 43312
Office
Unavailable
Facility
$1410.68
No comparable office rate is available.
Rest Of California
California · 43312
Office
Unavailable
Facility
$1410.68
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 43312
Office
Unavailable
Facility
$1487.87
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 43312
Office
Unavailable
Facility
$1447.91
No comparable office rate is available.
Salinas
California · 43312
Office
Unavailable
Facility
$1442.01
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 43312
Office
Unavailable
Facility
$1453.07
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 43312
Office
Unavailable
Facility
$1556.14
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 43312
Office
Unavailable
Facility
$1547.96
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 43312
Office
Unavailable
Facility
$1598.08
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 43312
Office
Unavailable
Facility
$1564.66
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 43312
Office
Unavailable
Facility
$1422.96
No comparable office rate is available.
Santa Cruz-Watsonville
California · 43312
Office
Unavailable
Facility
$1448.48
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 43312
Office
Unavailable
Facility
$1441.15
No comparable office rate is available.
Santa Rosa-Petaluma
California · 43312
Office
Unavailable
Facility
$1460.76
No comparable office rate is available.
Stockton
California · 43312
Office
Unavailable
Facility
$1410.68
No comparable office rate is available.
Vallejo
California · 43312
Office
Unavailable
Facility
$1499.38
No comparable office rate is available.
Visalia
California · 43312
Office
Unavailable
Facility
$1410.68
No comparable office rate is available.
Yuba City
California · 43312
Office
Unavailable
Facility
$1410.68
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 43312
Office
Unavailable
Facility
$1608.11
No comparable office rate is available.
Miami
Florida · 43312
Office
Unavailable
Facility
$1858.07
No comparable office rate is available.
Chicago
Illinois · 43312
Office
Unavailable
Facility
$1798.18
No comparable office rate is available.
Manhattan
New York · 43312
Office
Unavailable
Facility
$1726.81
No comparable office rate is available.
Alaska*
Alaska · 43312
Office
Unavailable
Facility
$1865.54
No comparable office rate is available.
Alabama
Alabama · 43312
Office
Unavailable
Facility
$1338.59
No comparable office rate is available.
Arkansas
Arkansas · 43312
Office
Unavailable
Facility
$1321.76
No comparable office rate is available.
Arizona
Arizona · 43312
Office
Unavailable
Facility
$1435.17
No comparable office rate is available.
Colorado
Colorado · 43312
Office
Unavailable
Facility
$1455.70
No comparable office rate is available.
Connecticut
Connecticut · 43312
Office
Unavailable
Facility
$1570.20
No comparable office rate is available.
Delaware
Delaware · 43312
Office
Unavailable
Facility
$1455.70
No comparable office rate is available.
Fort Lauderdale
Florida · 43312
Office
Unavailable
Facility
$1676.68
No comparable office rate is available.
Rest Of Florida
Florida · 43312
Office
Unavailable
Facility
$1587.06
No comparable office rate is available.
Atlanta
Georgia · 43312
Office
Unavailable
Facility
$1534.42
No comparable office rate is available.
Rest Of Georgia
Georgia · 43312
Office
Unavailable
Facility
$1493.99
No comparable office rate is available.
Hawaii, Guam
Hawaii · 43312
Office
Unavailable
Facility
$1416.54
No comparable office rate is available.
Iowa
Iowa · 43312
Office
Unavailable
Facility
$1309.37
No comparable office rate is available.
Idaho
Idaho · 43312
Office
Unavailable
Facility
$1329.08
No comparable office rate is available.
East St. Louis
Illinois · 43312
Office
Unavailable
Facility
$1699.66
No comparable office rate is available.
Rest Of Illinois
Illinois · 43312
Office
Unavailable
Facility
$1589.21
No comparable office rate is available.
Suburban Chicago
Illinois · 43312
Office
Unavailable
Facility
$1678.69
No comparable office rate is available.
Indiana
Indiana · 43312
Office
Unavailable
Facility
$1334.20
No comparable office rate is available.
Kansas
Kansas · 43312
Office
Unavailable
Facility
$1331.96
No comparable office rate is available.
Kentucky
Kentucky · 43312
Office
Unavailable
Facility
$1426.52
No comparable office rate is available.
New Orleans
Louisiana · 43312
Office
Unavailable
Facility
$1494.51
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 43312
Office
Unavailable
Facility
$1435.72
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 43312
Office
Unavailable
Facility
$1546.66
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 43312
Office
Unavailable
Facility
$1460.22
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 43312
Office
Unavailable
Facility
$1571.74
No comparable office rate is available.
Rest Of Maryland
Maryland · 43312
Office
Unavailable
Facility
$1471.89
No comparable office rate is available.
Rest Of Maine
Maine · 43312
Office
Unavailable
Facility
$1364.91
No comparable office rate is available.
Southern Maine
Maine · 43312
Office
Unavailable
Facility
$1387.35
No comparable office rate is available.
Detroit
Michigan · 43312
Office
Unavailable
Facility
$1633.64
No comparable office rate is available.
Rest Of Michigan
Michigan · 43312
Office
Unavailable
Facility
$1484.84
No comparable office rate is available.
Minnesota
Minnesota · 43312
Office
Unavailable
Facility
$1317.64
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 43312
Office
Unavailable
Facility
$1455.71
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 43312
Office
Unavailable
Facility
$1465.43
No comparable office rate is available.
Rest Of Missouri
Missouri · 43312
Office
Unavailable
Facility
$1433.00
No comparable office rate is available.
Mississippi
Mississippi · 43312
Office
Unavailable
Facility
$1376.20
No comparable office rate is available.
Montana**
Montana · 43312
Office
Unavailable
Facility
$1478.18
No comparable office rate is available.
North Carolina
North Carolina · 43312
Office
Unavailable
Facility
$1372.71
No comparable office rate is available.
North Dakota**
North Dakota · 43312
Office
Unavailable
Facility
$1335.81
No comparable office rate is available.
Nebraska
Nebraska · 43312
Office
Unavailable
Facility
$1307.09
No comparable office rate is available.
New Hampshire
New Hampshire · 43312
Office
Unavailable
Facility
$1460.31
No comparable office rate is available.
Northern Nj
New Jersey · 43312
Office
Unavailable
Facility
$1600.72
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 43312
Office
Unavailable
Facility
$1566.36
No comparable office rate is available.
New Mexico
New Mexico · 43312
Office
Unavailable
Facility
$1503.29
No comparable office rate is available.
Nevada**
Nevada · 43312
Office
Unavailable
Facility
$1438.78
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 43312
Office
Unavailable
Facility
$1799.69
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 43312
Office
Unavailable
Facility
$1599.16
No comparable office rate is available.
Queens
New York · 43312
Office
Unavailable
Facility
$1697.89
No comparable office rate is available.
Rest Of New York
New York · 43312
Office
Unavailable
Facility
$1392.95
No comparable office rate is available.
Ohio
Ohio · 43312
Office
Unavailable
Facility
$1455.74
No comparable office rate is available.
Oklahoma
Oklahoma · 43312
Office
Unavailable
Facility
$1394.47
No comparable office rate is available.
Portland
Oregon · 43312
Office
Unavailable
Facility
$1464.03
No comparable office rate is available.
Rest Of Oregon
Oregon · 43312
Office
Unavailable
Facility
$1406.09
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 43312
Office
Unavailable
Facility
$1553.93
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 43312
Office
Unavailable
Facility
$1442.01
No comparable office rate is available.
Puerto Rico
Puerto Rico · 43312
Office
Unavailable
Facility
$1478.19
No comparable office rate is available.
Rhode Island
Rhode Island · 43312
Office
Unavailable
Facility
$1480.21
No comparable office rate is available.
South Carolina
South Carolina · 43312
Office
Unavailable
Facility
$1420.88
No comparable office rate is available.
South Dakota**
South Dakota · 43312
Office
Unavailable
Facility
$1318.97
No comparable office rate is available.
Tennessee
Tennessee · 43312
Office
Unavailable
Facility
$1341.33
No comparable office rate is available.
Austin
Texas · 43312
Office
Unavailable
Facility
$1469.71
No comparable office rate is available.
Beaumont
Texas · 43312
Office
Unavailable
Facility
$1435.88
No comparable office rate is available.
Brazoria
Texas · 43312
Office
Unavailable
Facility
$1430.80
No comparable office rate is available.
Dallas
Texas · 43312
Office
Unavailable
Facility
$1451.94
No comparable office rate is available.
Fort Worth
Texas · 43312
Office
Unavailable
Facility
$1452.21
No comparable office rate is available.
Galveston
Texas · 43312
Office
Unavailable
Facility
$1442.92
No comparable office rate is available.
Houston
Texas · 43312
Office
Unavailable
Facility
$1574.70
No comparable office rate is available.
Rest Of Texas
Texas · 43312
Office
Unavailable
Facility
$1440.77
No comparable office rate is available.
Utah
Utah · 43312
Office
Unavailable
Facility
$1436.99
No comparable office rate is available.
Virginia
Virginia · 43312
Office
Unavailable
Facility
$1403.10
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 43312
Office
Unavailable
Facility
$1478.19
No comparable office rate is available.
Vermont
Vermont · 43312
Office
Unavailable
Facility
$1357.00
No comparable office rate is available.
Rest Of Washington
Washington · 43312
Office
Unavailable
Facility
$1448.70
No comparable office rate is available.
Seattle (King Cnty)
Washington · 43312
Office
Unavailable
Facility
$1547.10
No comparable office rate is available.
Wisconsin
Wisconsin · 43312
Office
Unavailable
Facility
$1300.25
No comparable office rate is available.
West Virginia
West Virginia · 43312
Office
Unavailable
Facility
$1544.90
No comparable office rate is available.
Wyoming**
Wyoming · 43312
Office
Unavailable
Facility
$1416.13
No comparable office rate is available.
See how rates vary across the country
43312 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Madera is a Medicare payment area. Our Census mapping connects it to 17 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 43312 in Madera. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1551.75
$1410.68 × 110% = $1551.75
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43312 in Madera.
PPRRVU2026_Oct_nonQPP.csv
5,221
- Code
- 43312
- Physician work
- 28.52
- Practice expense
- 8.55
- Malpractice
- 7.20
GPCI2026.csv
14
- Locality
- Madera
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 28.52 | × 1.017 | 29.0048 |
| Practice expense | 8.55 | × 1.096 | 9.3708 |
| Malpractice | 7.20 | × 0.536 | 3.8592 |
| Total RVUs | 42.2348 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Madera$1410.68
Open 43312 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 28.52 | 1.017 |
| Practice expense | 8.55 | 1.096 |
| Malpractice | 7.2 | 0.536 |
(28.52 × 1.017 + 8.55 × 1.096 + 7.2 × 0.536) × $33.4009 = $1410.68
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
43312 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1410.68 | RVU26D |
| 2026-07-01 | Not available in this setting | $1410.68 | RVU26C |
| 2026-04-01 | Not available in this setting | $1410.68 | RVU26B |
| 2026-01-01 | Not available in this setting | $1410.68 | RVU26A |
| 2025-10-01 | Not available in this setting | $1461.89 | RVU25D |
| 2025-07-01 | Not available in this setting | $1461.89 | RVU25C |
| 2025-04-01 | Not available in this setting | $1461.89 | RVU25B |
| 2025-01-01 | Not available in this setting | $1461.89 | RVU25A |
43312 billing questions
How does this differ from 43310?
Both involve a thoracic approach, but 43312 includes repair of a tracheoesophageal fistula. Use 43310 when the thoracic esophageal repair does not include fistula repair.
How does this differ from 43305?
Both include fistula repair, but 43305 is the cervical-approach counterpart. The operative report should support the approach used.
Can the fistula closure be reported separately?
The fistula repair is part of this service. Do not report a separate code for the same fistula-closure work.
Does Medicare apply a 90-day global period?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Should modifier 50 be used for a fistula on each side?
No. Medicare's bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,21843305,,Repair esophagus and fistula,A,,17.65,8.02,NA,8.02,,2.58,28.25,28.25,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2194330F,,Cnslng epi spec sfty issues,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22043310,,Repair of esophagus,A,,25.60,9.89,NA,9.89,,6.44,41.93,41.93,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22143312,,Repair esophagus and fistula,A,,28.52,8.55,NA,8.55,,7.20,44.27,44.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22243313,,Esophagoplasty congenital,A,,47.24,21.21,NA,21.21,,12.66,81.11,81.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22343314,,Tracheo-esophagoplasty cong,A,,52.09,19.92,NA,19.92,,13.96,85.97,85.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22443320,,Fuse esophagus & stomach,A,,22.73,10.35,NA,10.35,,6.08,39.16,39.16,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1101112,CA,56,FRESNO,1.017,1.096,0.536
1201112,CA,57,HANFORD-CORCORAN,1.017,1.096,0.536
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508