43210 Endoscopic fundoplasty Medicare reimbursement rates in Georgia

This therapeutic upper endoscopy creates an antireflux valve at the junction of the esophagus and stomach using an endoscopic fastening device. It is commonly performed as transoral incisionless fundoplication for selected patients with gastroesophageal reflux disease. A gastroenterologist or foregut surgeon typically performs it in a hospital or ambulatory endoscopy setting. The endoscope also permits evaluation of the upper gastrointestinal tract, including the duodenum when examined; the defining service is the fundoplasty, not diagnostic inspection alone.

Report the code when the endoscopic fundoplasty is actually performed, and document the indication, relevant anatomy and findings, and completion of the valve-forming work. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate for this procedure at the single esophagogastric junction. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.