No office rate
43420 is used to close an esophagostomy. Choose 43425 when the operative target is an esophageal fistula.
On this page
CMS RVU26D · Effective 2026-10-01
43425 Fistula repair Medicare reimbursement rates in Connecticut
Reports operative repair of an esophageal fistula, such as a persistent abnormal connection requiring surgical closure by an esophageal surgeon. Compare 43425 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 43425 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
$1462.61
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 43425: Esophageal fistula repair
Reports operative repair of an esophageal fistula, such as a persistent abnormal connection requiring surgical closure by an esophageal surgeon.
This code describes an operation to close or repair an abnormal fistulous opening involving the esophagus. A thoracic or general surgeon typically performs the repair in an operating room, often in a hospital setting. The operative report should identify the fistula, its relationship to the esophagus, the surgical approach, and the repair performed. A persistent fistula after prior esophageal surgery is one clinical situation in which this type of repair may be considered.
Report the code when the documented operation is directed at an esophageal fistula; distinguish it from repair of an esophageal wound or closure of an esophagostomy. This major surgery code includes 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 multiple procedure reduction. Modifier 50 is inappropriate for this anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43425
- 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 RVU24.41 · 59%
- Practice expense (office) RVU10.62 · 26%
- Malpractice RVU6.16 · 15%
24
Medicare services in 2024 · #5814 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.
43425 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
43410 describes repair of an esophageal wound by a cervical approach. A fistula repair is described by 43425.
No office rate
43415 describes repair of an esophageal wound by a thoracic approach. Use 43425 for repair of an esophageal fistula.
Compare 43425 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
$1462.61
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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 43425 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,249
- Code
- 43425
- Physician work
- 24.41
- Practice expense
- 10.62
- Malpractice
- 6.16
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 24.41 | × 1.020 | 24.8982 |
| Practice expense | 10.62 | × 1.077 | 11.4377 |
| Malpractice | 6.16 | × 1.210 | 7.4536 |
| Total RVUs | 43.7895 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$1462.61
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 24.41 | 1.02 |
| Practice expense | 10.62 | 1.077 |
| Malpractice | 6.16 | 1.21 |
(24.41 × 1.02 + 10.62 × 1.077 + 6.16 × 1.21) × $33.4009 = $1462.61
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.
43425 billing questions
How is this code distinguished from 43420?
Use the operative target documented by the surgeon. Code 43425 is for repair of an esophageal fistula; 43420 is for closure of an esophagostomy.
Is this code used for an esophageal wound?
No. Codes 43410 and 43415 describe repair of an esophageal wound, with the approach distinguishing those codes. This code is for fistula repair.
Are related postoperative visits included?
Yes. 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 used for fistulas on both sides?
No. The anatomy and descriptor make modifier 50 inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard multiple procedure reduction.
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.
5,24643410,,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
5,25143453,,Dilate esophagus,A,,1.37,23.35,,0.77,,0.18,24.90,2.32,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25243460,,Pressure treatment esophagus,A,,3.70,1.50,NA,1.50,,0.42,5.62,5.62,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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