No office rate
43300 identifies a specific esophageal repair service. Choose it when the operative work matches that defined service rather than relying on the broader gastrointestinal repair label for 43360.
On this page
CMS RVU26D · Effective 2026-10-01
43360 GI repair Medicare reimbursement rates in Colorado
Reports operative repair of gastrointestinal tissue when the surgeon treats a defect or injury requiring surgical correction during a major procedure. Compare 43360 office and facility rates across CMS payment localities in Colorado.
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 43360 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2096.19
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
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.
Gastrointestinal surgery
About 43360: Gastrointestinal tract repair surgery
Reports operative repair of gastrointestinal tissue when the surgeon treats a defect or injury requiring surgical correction during a major procedure.
CPT 43360 represents operative repair of gastrointestinal tissue. It is performed by a surgeon when a defect or injury requires direct surgical correction, rather than a diagnostic examination or a separately defined reconstruction. The operative report should identify the treated site, the nature of the defect or injury, the repair performed, and any associated procedures. Claims for this service are most commonly associated with facility surgery; CMS recorded facility services for this code in 2024.
This major surgery has a 90-day global period: the day-before preoperative visit and related postoperative care during the following 90 days are included. When multiple procedures are performed in one 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 code. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. The operative note should support the distinct work and any separately reported procedures.
CMS billing rules for 43360
- 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 RVU39.11 · 62%
- Practice expense (office) RVU14.54 · 23%
- Malpractice RVU9.87 · 16%
22
Medicare services in 2024 · #5870 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.
43360 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
43305 describes esophageal repair that includes fistula repair. The operative report must support that additional work to distinguish it from 43360.
No office rate
43310 is another specifically described esophageal repair option. Compare its full procedure definition with the documented anatomy and operative technique.
No office rate
43312 describes esophageal repair with fistula repair. Use it when the operation includes that defined work, rather than selecting 43360 from a general description alone.
Compare 43360 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.
1 of 1 payment localities
Colorado →
Office / nonfacility
Unavailable
Facility
$2096.19
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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 43360 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,241
- Code
- 43360
- Physician work
- 39.11
- Practice expense
- 14.54
- Malpractice
- 9.87
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 39.11 | × 1.012 | 39.5793 |
| Practice expense | 14.54 | × 1.064 | 15.4706 |
| Malpractice | 9.87 | × 0.781 | 7.7085 |
| Total RVUs | 62.7584 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$2096.19
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 39.11 | 1.012 |
| Practice expense | 14.54 | 1.064 |
| Malpractice | 9.87 | 0.781 |
(39.11 × 1.012 + 14.54 × 1.064 + 9.87 × 0.781) × $33.4009 = $2096.19
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.
43360 billing questions
How should I distinguish 43360 from other gastrointestinal repair codes?
Use the operative report to identify the precise procedure and anatomy, then compare that work with the more specifically described esophageal repair options. Do not select 43360 based only on a general reference to gastrointestinal repair.
What documentation supports reporting 43360?
Document the site and nature of the defect or injury, the surgical repair performed, and any associated procedures. The operative report should make the work represented by this code clear.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care during the 90 days after surgery are included in the global period.
Can an assistant surgeon or co-surgeon be paid?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to reduction. The record should support each separately reported service.
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.
5,23843341,,Fuse esophagus & intestine,A,,23.62,10.47,NA,10.47,,5.96,40.05,40.05,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23943351,,Surgical opening esophagus,A,,21.50,11.28,NA,11.28,,5.41,38.19,38.19,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24043352,,Surgical opening esophagus,A,,17.36,9.24,NA,9.24,,4.36,30.96,30.96,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24143360,,Gastrointestinal repair,A,,39.11,14.54,NA,14.54,,9.87,63.52,63.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24243361,,Gastrointestinal repair,A,,44.54,18.60,NA,18.60,,11.94,75.08,75.08,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24343400,,Ligate esophagus veins,A,,24.96,10.89,NA,10.89,,6.67,42.52,42.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24443405,,Ligate/staple esophagus,A,,24.11,11.80,NA,11.80,,6.07,41.98,41.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899