CPT code 43425: Fistula repair2026 Medicare rate & RVUs in Alaska
Reports operative repair of an esophageal fistula, such as a persistent abnormal connection requiring surgical closure by an esophageal surgeon.
CMS doesn’t publish an office rate for 43425 in Alaska.
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 9 sections
What 43425 covers
This code describes an operation to close or repair an abnormal fistulous opening involving the esophagus. A thoracic or general surgeon typically performs the repair in an operating room, often in a hospital setting. The operative report should identify the fistula, its relationship to the esophagus, the surgical approach, and the repair performed. A persistent fistula after prior esophageal surgery is one clinical situation in which this type of repair may be considered.
Report the code when the documented operation is directed at an esophageal fistula; distinguish it from repair of an esophageal wound or closure of an esophagostomy. This major surgery code 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 multiple procedure reduction. Modifier 50 is inappropriate for this anatomy. 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.
43425 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $1,714.12 |
How the 43425 rate is calculated
Each of 43425’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 · 43425
RVUs × geographic indexes × conversion factor
Work24.41
24.41 RVUs× 1.000 GPCI
Practice expense10.62
10.62 RVUs× 1.000 GPCI
Malpractice6.16
6.16 RVUs× 1.000 GPCI
Adjusted RVUs
41.1900
Conversion factor
$33.4009
Medicare rate
$1,375.78
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43425
43425 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43425
Fistula repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43425
Fistula 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43425 without 51 · national facility
$1,375.78
Fistula repair
43425-51 · Second procedure: 50%
$687.89
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%).
43425 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43420Esophageal repair
- 43420 is used to close an esophagostomy. Choose 43425 when the operative target is an esophageal fistula.
- 43410Esophageal repair
- 43410 describes repair of an esophageal wound by a cervical approach. A fistula repair is described by 43425.
- 43415Esophageal repair
- 43415 describes repair of an esophageal wound by a thoracic approach. Use 43425 for repair of an esophageal fistula.
43425 billing questions
How is this code distinguished from 43420?
Use the operative target documented by the surgeon. Code 43425 is for repair of an esophageal fistula; 43420 is for closure of an esophagostomy.
Is this code used for an esophageal wound?
No. Codes 43410 and 43415 describe repair of an esophageal wound, with the approach distinguishing those codes. This code is for fistula repair.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
Should modifier 50 be used for fistulas on both sides?
No. The anatomy and descriptor make modifier 50 inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard multiple procedure reduction.
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
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