43333 Hernia repair Medicare reimbursement rates in Arizona

Code 43333 represents operative repair of a paraesophageal hiatal hernia through an abdominal approach, with mesh reinforcement at the hiatus. The surgeon reduces herniated stomach or other displaced viscera from the chest and reconstructs the hiatus; fundoplasty may be performed as part of the repair. This major foregut operation is generally performed by a general or thoracic surgeon in a hospital operating room, often for a large hernia associated with obstructive symptoms, reflux, or risk of volvulus. The transabdominal route distinguishes it from transthoracic repair, while mesh distinguishes it from 43332.

Report 43333 when documentation establishes the paraesophageal hernia, transabdominal approach, and mesh use; describe the repair and any fundoplasty. Fundoplasty performed as part of the hernia operation is included rather than separately reported as a distinct service. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is inappropriate for this single hiatal repair. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.