No office rate
The thoracoabdominal approach is shared, but 43337 is reported when mesh is used. This code describes repair without mesh.
On this page
CMS RVU26D · Effective 2026-10-01
43336 Hernia repair Medicare reimbursement rates in Delaware
Open thoracoabdominal repair of a diaphragmatic hernia without mesh, reported when the surgeon uses combined chest and abdominal access. Compare 43336 office and facility rates across CMS payment localities in Delaware.
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 43336 in Delaware?
Delaware 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
$1343.16
1 of 1 localities have a supported rate.
Payment area: Delaware
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.
General surgery
About 43336: Thoracoabdominal diaphragmatic hernia repair without mesh
Open thoracoabdominal repair of a diaphragmatic hernia without mesh, reported when the surgeon uses combined chest and abdominal access.
This code describes open repair of a diaphragmatic hernia through a thoracoabdominal approach, using access through both the chest and abdomen. General or thoracic surgeons may perform it in a hospital operating room for a hernia requiring this combined exposure. The repair is reported without mesh; the operative approach and whether mesh was used distinguish it from nearby options. A transabdominal repair of a paraesophageal hiatal hernia is a different service.
Select the code from the operative report’s documented hernia repair, access route, and use or absence of mesh. The report should support the diaphragmatic defect treated and the combined approach. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other 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 not appropriate for this repair. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43336
- 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 RVU25.16 · 62%
- Practice expense (office) RVU9.34 · 23%
- Malpractice RVU6.34 · 16%
31
Medicare services in 2024 · #5645 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.
43336 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
43334 uses a transthoracic approach for diaphragmatic hernia repair without mesh. This code requires the combined thoracoabdominal approach.
No office rate
43332 describes transabdominal repair of a paraesophageal hiatal hernia without fundoplasty. This code describes thoracoabdominal repair of a diaphragmatic hernia.
Compare 43336 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
Delaware →
Office / nonfacility
Unavailable
Facility
$1343.16
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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 43336 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,234
- Code
- 43336
- Physician work
- 25.16
- Practice expense
- 9.34
- Malpractice
- 6.34
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 25.16 | × 1.005 | 25.2858 |
| Practice expense | 9.34 | × 0.988 | 9.2279 |
| Malpractice | 6.34 | × 0.899 | 5.6997 |
| Total RVUs | 40.2134 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$1343.16
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 25.16 | 1.005 |
| Practice expense | 9.34 | 0.988 |
| Malpractice | 6.34 | 0.899 |
(25.16 × 1.005 + 9.34 × 0.988 + 6.34 × 0.899) × $33.4009 = $1343.16
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.
43336 billing questions
How does this differ from 43337?
Both describe thoracoabdominal diaphragmatic hernia repair. This code is for repair without mesh; 43337 is the mesh version.
When would 43334 or 43335 be more appropriate?
Those codes describe diaphragmatic hernia repair through a transthoracic approach. Choose between them and this code based on the operative approach documented.
Is a paraesophageal hiatal hernia repair reported with this code?
Not when the documented service is a transabdominal paraesophageal hiatal hernia repair. Codes 43332 and 43333 describe that different service.
What documentation supports this code?
The operative report should establish the diaphragmatic hernia treated, the thoracoabdominal approach, and that mesh was not used.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the 90-day global period affect postoperative services?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the global surgery payment.
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.
5,23143333,,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
5,23343335,,Transthor diaphrag hern rpr,A,,23.37,8.26,NA,8.26,,5.88,37.51,37.51,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23443336,,Thorabd diaphr hern repair,A,,25.16,9.34,NA,9.34,,6.34,40.84,40.84,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23543337,,Thorabd diaphr hern repair,A,,26.96,9.70,NA,9.70,,6.78,43.44,43.44,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23643338,,Esoph lengthening,A,,2.15,0.42,NA,0.42,,0.53,3.10,3.10,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23743340,,Fuse esophagus & intestine,A,,22.42,10.27,NA,10.27,,6.00,38.69,38.69,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503