No office rate
Use 43410 for an esophageal wound repaired through a cervical approach; use 43415 for a thoracic or abdominal approach.
On this page
CMS RVU26D · Effective 2026-10-01
43415 Esophageal repair Medicare reimbursement rates in Colorado
Open repair of an esophageal wound through a thoracic or abdominal approach, typically reported for operative treatment of an injury or perforation. Compare 43415 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 43415 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
$2389.01
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.
Esophageal surgery
About 43415: Esophageal wound repair, thoracic or abdominal approach
Open repair of an esophageal wound through a thoracic or abdominal approach, typically reported for operative treatment of an injury or perforation.
This code describes operative repair of an esophageal wound reached through the chest or abdomen. It may be used for a traumatic injury or an esophageal perforation requiring open surgical closure. A thoracic or general surgeon typically performs the repair in a hospital operating room; the approach documented in the operative report distinguishes it from cervical repair.
Report the code when the surgeon’s work addresses a wound in the esophagus, not closure of a surgically created esophagostomy. The operative report should identify the injury, its location, the approach, and the repair performed. CMS assigns a 90-day global period, including 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 50% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43415
- 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 RVU43.76 · 61%
- Practice expense (office) RVU17.52 · 24%
- Malpractice RVU11.01 · 15%
117
Medicare services in 2024 · #4760 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.
43415 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
43420 addresses closure of a surgically created esophagostomy through a cervical approach, not repair of an esophageal wound.
No office rate
43425 is for closure of an esophagostomy through a thoracic or abdominal approach. 43415 repairs an esophageal wound using those approaches.
Compare 43415 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
$2389.01
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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 43415 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,247
- Code
- 43415
- Physician work
- 43.76
- Practice expense
- 17.52
- Malpractice
- 11.01
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 43.76 | × 1.012 | 44.2851 |
| Practice expense | 17.52 | × 1.064 | 18.6413 |
| Malpractice | 11.01 | × 0.781 | 8.5988 |
| Total RVUs | 71.5252 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$2389.01
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 43.76 | 1.012 |
| Practice expense | 17.52 | 1.064 |
| Malpractice | 11.01 | 0.781 |
(43.76 × 1.012 + 17.52 × 1.064 + 11.01 × 0.781) × $33.4009 = $2389.01
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.
43415 billing questions
How does this differ from 43410?
43415 is for repair through a thoracic or abdominal approach. 43410 is the cervical-approach repair.
Can this be used to close an esophagostomy?
No. Closure of a surgically created esophagostomy is described by codes such as 43420 or 43425, depending on the approach.
What documentation supports reporting 43415?
The operative report should establish that an esophageal wound was repaired and document its location, the thoracic or abdominal approach, and the repair performed.
How does the global period affect billing?
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 appended for an esophageal wound?
No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.
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.
5,24443405,,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
5,2454340F,,Cnslng chldbrng women epi,M,,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
5,24643410,,Repair esophagus wound,A,,16.00,8.67,NA,8.67,,2.34,27.01,27.01,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24743415,,Repair esophagus wound,A,,43.76,17.52,NA,17.52,,11.01,72.29,72.29,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24843420,,Repair esophagus opening,A,,16.36,7.56,NA,7.56,,2.39,26.31,26.31,0,090,0.09,0.81,0.10,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24943425,,Repair esophagus opening,A,,24.41,10.62,NA,10.62,,6.16,41.19,41.19,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25043450,,Dilate esophagus 1/mult pass,A,,1.25,4.95,,0.79,,0.15,6.35,2.19,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,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