Billing code 43331: Esophageal myotomyMedicare rate & RVUs in Georgia
Reports a thoracic approach to esophageal muscle division, commonly for achalasia, with fundoplasty included when performed during the operation.
CMS doesn’t publish an office rate for 43331 in Georgia.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 43331 covers
This operation divides the esophageal muscle through a thoracic approach to relieve impaired passage, most commonly in a patient with achalasia. A thoracic or general surgeon typically performs it in a hospital operating room. The surgeon may add a fundoplasty during the same operation; that option is encompassed by this service rather than treated as a separate fundoplasty procedure.
Select this code based on the thoracic route and the operative work, not on disease severity. The operative report should identify the approach, the myotomy performed, and any fundoplasty. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this single esophageal operation. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
Where 43331 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | Unavailable | $1,327.99 |
| Rest Of Georgia | Unavailable | $1,281.58 |
How the 43331 rate is calculated
Each of 43331’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43331
RVUs × geographic indexes × conversion factor
Work22.48
22.48 RVUs× 1.000 GPCI
Practice expense10.25
10.25 RVUs× 1.000 GPCI
Malpractice5.66
5.66 RVUs× 1.000 GPCI
Adjusted RVUs
38.3900
Conversion factor
$33.4009
Medicare rate
$1,282.26
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43331
43331 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43331
Esophageal myotomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43331
Esophageal myotomy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43331 without 51 · national facility
$1,282.26
Esophageal myotomy
43331-51 · Second procedure: 50%
$641.13
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43331 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43330Esophageal myotomy
- Choose 43331 for the thoracic route and 43330 for the abdominal route; the access approach, not the diagnosis, distinguishes them.
- 43279Heller myotomy
- This code represents a laparoscopic Heller-type myotomy. Use 43331 when the documented operation uses a thoracic approach.
- 43499Unlisted procedure esophagus
- This is an unlisted esophageal procedure code that may be used for POEM. It is not the code for a thoracic surgical myotomy.
43331 billing questions
How does this differ from 43330?
The operative route determines the choice: 43331 is for a thoracic approach, while 43330 is for an abdominal approach.
Can a fundoplasty be billed separately with this code?
A fundoplasty performed as part of the myotomy is included in this service. The operative report should describe it when performed.
Should modifier 50 be reported?
No. Modifier 50 is not appropriate for this operation on the esophagus.
What documentation supports the thoracic approach?
The operative report should establish the thoracic route and describe the esophageal muscle division, along with any fundoplasty performed.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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