No office rate
43320 concerns creating an esophagus-to-stomach connection. 43325 revises a connection that already exists.
On this page
CMS RVU26D · Effective 2026-10-01
43325 Anastomosis revision Medicare reimbursement rates in Connecticut
Report this code when a surgeon revises an existing esophagus-to-stomach connection through an abdominal approach, commonly to address an anastomotic stricture. Compare 43325 office and facility rates across CMS payment localities in Connecticut.
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 43325 in Connecticut?
Connecticut 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
$1355.13
1 of 1 localities have a supported rate.
Payment area: Connecticut
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 43325: Abdominal esophagogastric anastomosis revision
Report this code when a surgeon revises an existing esophagus-to-stomach connection through an abdominal approach, commonly to address an anastomotic stricture.
This operation revises an existing connection between the esophagus and stomach through an abdominal approach. A surgeon may perform it when a prior reconstruction has left a narrowed or otherwise problematic anastomosis. Repair of a hiatal hernia may be part of the operation. The service is typically performed in an operating room, often in a hospital setting, by a surgeon managing the patient’s esophageal reconstruction.
Select the code when the operative report supports revision of the prior connection and an abdominal approach; distinguish it from creating a new connection or performing an antireflux procedure. Document the indication, prior anastomosis, approach, and work performed. The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this single junction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43325
- 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 RVU22.04 · 58%
- Practice expense (office) RVU10.18 · 27%
- Malpractice RVU5.89 · 15%
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.
43325 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
43327 is laparoscopic fundoplasty for an antireflux procedure. It is not the code for revising a narrowed or problematic prior anastomosis.
Compare 43325 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$1355.13
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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 43325 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,225
- Code
- 43325
- Physician work
- 22.04
- Practice expense
- 10.18
- Malpractice
- 5.89
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 22.04 | × 1.020 | 22.4808 |
| Practice expense | 10.18 | × 1.077 | 10.9639 |
| Malpractice | 5.89 | × 1.210 | 7.1269 |
| Total RVUs | 40.5716 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$1355.13
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 22.04 | 1.02 |
| Practice expense | 10.18 | 1.077 |
| Malpractice | 5.89 | 1.21 |
(22.04 × 1.02 + 10.18 × 1.077 + 5.89 × 1.21) × $33.4009 = $1355.13
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.
43325 billing questions
How is 43325 distinguished from 43326?
43325 is for revision through an abdominal approach; 43326 is the thoracic-approach counterpart. The operative report should identify the approach used.
Can a hiatal hernia repair be included?
Yes. Hiatal hernia repair may be performed as part of the anastomosis revision; document the work in the operative report.
Is this code for creating a new esophagus-to-stomach connection?
No. It describes revision of an existing connection. A procedure that creates the connection is distinct and should be selected based on the work performed.
What does the 90-day global period include?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.
Should modifier 50 be reported?
No. This revision involves a single esophagogastric junction, so modifier 50 is inappropriate.
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.
5,22243313,,Esophagoplasty congenital,A,,47.24,21.21,NA,21.21,,12.66,81.11,81.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22343314,,Tracheo-esophagoplasty cong,A,,52.09,19.92,NA,19.92,,13.96,85.97,85.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22443320,,Fuse esophagus & stomach,A,,22.73,10.35,NA,10.35,,6.08,39.16,39.16,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22543325,,Revise esophagus & stomach,A,,22.04,10.18,NA,10.18,,5.89,38.11,38.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22643327,,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
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808