No office rate
Choose 43331 for the thoracic route and 43330 for the abdominal route; the access approach, not the diagnosis, distinguishes them.
On this page
CMS RVU26D · Effective 2026-10-01
43331 Esophageal myotomy Medicare reimbursement rates in California
Reports a thoracic approach to esophageal muscle division, commonly for achalasia, with fundoplasty included when performed during the operation. Compare 43331 office and facility rates across CMS payment localities in California.
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.
What does Medicare pay for 43331 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1240.17–$1428.46
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $188.29 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 43331 pays more and less in California
Esophageal surgery
About 43331: Thoracic approach esophageal myotomy
Reports a thoracic approach to esophageal muscle division, commonly for achalasia, with fundoplasty included when performed during the operation.
This operation divides the esophageal muscle through a thoracic approach to relieve impaired passage, most commonly in a patient with achalasia. A thoracic or general surgeon typically performs it in a hospital operating room. The surgeon may add a fundoplasty during the same operation; that option is encompassed by this service rather than treated as a separate fundoplasty procedure.
Select this code based on the thoracic route and the operative work, not on disease severity. The operative report should identify the approach, the myotomy performed, and any fundoplasty. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this single esophageal operation. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43331
- 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 RVU22.48 · 59%
- Practice expense (office) RVU10.25 · 27%
- Malpractice RVU5.66 · 15%
14
Medicare services in 2024 · #6102 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.
43331 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
This code represents a laparoscopic Heller-type myotomy. Use 43331 when the documented operation uses a thoracic approach.
43499
No office rateUnlisted procedure esophagus
This is an unlisted esophageal procedure code that may be used for POEM. It is not the code for a thoracic surgical myotomy.
Compare 43331 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $1255.48 |
| Chico | Office Unavailable | Facility $1240.17 |
| El Centro | Office Unavailable | Facility $1241.12 |
| Fresno | Office Unavailable | Facility $1240.17 |
| Hanford-Corcoran | Office Unavailable | Facility $1240.17 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1312.18 |
| Madera | Office Unavailable | Facility $1240.17 |
| Merced | Office Unavailable | Facility $1240.17 |
| Modesto | Office Unavailable | Facility $1240.17 |
| Napa | Office Unavailable | Facility $1345.42 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1294.32 |
| Redding | Office Unavailable | Facility $1240.17 |
| Rest Of California | Office Unavailable | Facility $1240.17 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1300.85 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1277.38 |
| Salinas | Office Unavailable | Facility $1272.25 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1285.30 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1391.68 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1385.26 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1428.46 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1402.18 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1254.89 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1283.92 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1272.40 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1295.13 |
| Stockton | Office Unavailable | Facility $1240.17 |
| Vallejo | Office Unavailable | Facility $1336.16 |
| Visalia | Office Unavailable | Facility $1240.17 |
| Yuba City | Office Unavailable | Facility $1240.17 |
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43331 billing questions
How does this differ from 43330?
The operative route determines the choice: 43331 is for a thoracic approach, while 43330 is for an abdominal approach.
Can a fundoplasty be billed separately with this code?
A fundoplasty performed as part of the myotomy is included in this service. The operative report should describe it when performed.
Should modifier 50 be reported?
No. Modifier 50 is not appropriate for this operation on the esophagus.
What documentation supports the thoracic approach?
The operative report should establish the thoracic route and describe the esophageal muscle division, along with any fundoplasty performed.
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.
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.
5,22643327,,Esoph fundoplasty lap,A,,13.02,7.20,NA,7.20,,3.47,23.69,23.69,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22743328,,Esoph fundoplasty thor,A,,19.41,7.48,NA,7.48,,4.88,31.77,31.77,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22843330,,Esophagomyotomy abdominal,A,,21.64,10.08,NA,10.08,,5.77,37.49,37.49,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22943331,,Esophagomyotomy thoracic,A,,22.48,10.25,NA,10.25,,5.66,38.39,38.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23043332,,Transab esoph hiat hern rpr,A,,19.13,8.26,NA,8.26,,4.88,32.27,32.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23143333,,Transab esoph hiat hern rpr,A,,20.92,8.87,NA,8.87,,5.41,35.20,35.20,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23243334,,Transthor diaphrag hern rpr,A,,21.57,7.91,NA,7.91,,5.45,34.93,34.93,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00