CPT 43338: Esophageal lengtheningMedicare rate & RVUs in Guam
Reports surgical lengthening of a shortened esophagus, such as Collis gastroplasty, performed as an adjunct during an esophageal or hiatal hernia operation.
CMS doesn’t publish an office rate for 43338 in Guam.
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 43338 covers
This add-on describes an operation that lengthens the esophagus, commonly by creating a tubular extension from the stomach in a Collis gastroplasty. A surgeon may perform it when a short esophagus prevents adequate positioning below the diaphragm during repair of a paraesophageal or hiatal hernia. It is an operative service, not routine mobilization of the esophagus or a standalone diagnostic procedure.
Report 43338 only with the primary operation for which the lengthening was performed; it is not billed by itself. The operative report should identify the short esophagus, the lengthening technique, and the associated primary procedure. CMS classifies this as an add-on code, paid within the primary procedure's global period. The add-on payment is therefore handled as part of that primary procedure's global surgical episode.
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.
43338 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $98.01 |
How the 43338 rate is calculated
Each of 43338’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 · 43338
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.15Practice expense 0.42Malpractice 0.53
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43338
The CMS indicators that decide how 43338 is paid alongside other services.
CMS payment indicators · 43338
Esophageal lengthening
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
43338 without 80 · national facility
$103.54
Esophageal lengthening
43338-80 · Assistant: 16%
$16.57
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
43338 compared with similar codes
Compare codes
43338 vs 43327 vs 43328 vs 43313: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43327Fundoplasty
- 43327 reports laparoscopic esophagogastric fundoplasty. Use 43338 only when the surgeon also performs an esophageal lengthening procedure.
- 43328Fundoplasty
- 43328 reports thoracic esophagogastric fundoplasty; it does not by itself describe lengthening a short esophagus.
- 43313Esophageal repair
- 43313 concerns congenital esophageal reconstruction, whereas 43338 describes an adjunctive lengthening procedure such as Collis gastroplasty.
43338 billing questions
When is esophageal lengthening separately reported?
Report 43338 when the surgeon performs a distinct lengthening procedure, such as a Collis gastroplasty, in addition to the primary operation. Routine esophageal mobilization alone does not describe this service.
Can 43338 be billed by itself?
No. CMS identifies 43338 as an add-on code that must be billed with a primary procedure.
What documentation supports 43338?
The operative report should describe the short esophagus, the lengthening performed, and the primary operation performed during the same surgical episode.
Is a fundoplication alone enough to report 43338?
No. A fundoplication does not establish that esophageal lengthening was performed. The record must document the additional lengthening procedure.
How does the global period affect payment?
CMS pays 43338 within the global period of its primary procedure. It is not treated as a separate standalone surgical episode.
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
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