No office rate
This code creates an esophagus-to-stomach connection. Code 43325 describes revision of an existing esophagogastric anastomosis.
On this page
CMS RVU26D · Effective 2026-10-01
43320 Esophageal reconstruction Medicare reimbursement rates in Idaho
Reports surgical reconstruction connecting the esophagus to the stomach, commonly when the stomach serves as a conduit after esophageal resection. Compare 43320 office and facility rates across CMS payment localities in Idaho.
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 43320 in Idaho?
Idaho 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
$1173.30
1 of 1 localities have a supported rate.
Payment area: Idaho
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.
Gastrointestinal surgery
About 43320: Esophagus-to-stomach reconstruction
Reports surgical reconstruction connecting the esophagus to the stomach, commonly when the stomach serves as a conduit after esophageal resection.
A surgeon creates a connection between the esophagus and stomach, often using the stomach to restore continuity after part of the esophagus has been removed. The operation is performed in a surgical setting by a thoracic or gastrointestinal surgeon. A pyloroplasty may also be performed as part of the reconstruction and is included in this service.
Report this code when the operative record supports creation of the esophagus-to-stomach connection; document the reconstruction, the anatomy involved, and any associated pyloroplasty. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. If multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this single reconstruction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43320
- 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 RVU22.73 · 58%
- Practice expense (office) RVU10.35 · 26%
- Malpractice RVU6.08 · 16%
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.
43320 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
Choose 43320 when the esophagus is connected to the stomach; 43340 is for connection to intestine.
No office rate
Code 43327 describes laparoscopic esophagogastric fundoplasty, an antireflux operation rather than reconstruction of esophageal continuity.
Compare 43320 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
Idaho →
Office / nonfacility
Unavailable
Facility
$1173.30
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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 43320 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
5,224
- Code
- 43320
- Physician work
- 22.73
- Practice expense
- 10.35
- Malpractice
- 6.08
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 22.73 | × 1.000 | 22.7300 |
| Practice expense | 10.35 | × 0.920 | 9.5220 |
| Malpractice | 6.08 | × 0.473 | 2.8758 |
| Total RVUs | 35.1278 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$1173.30
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 22.73 | 1 |
| Practice expense | 10.35 | 0.92 |
| Malpractice | 6.08 | 0.473 |
(22.73 × 1 + 10.35 × 0.92 + 6.08 × 0.473) × $33.4009 = $1173.30
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.
43320 billing questions
When should this code be selected instead of an esophagoenterostomy code?
Use this code when the reconstruction connects the esophagus to the stomach. Esophagoenterostomy codes describe a connection to intestine instead.
Is pyloroplasty separately reported with this reconstruction?
A pyloroplasty performed as part of this reconstruction is included in the service.
Does modifier 50 apply?
No. The procedure creates one esophagus-to-stomach connection, not a bilateral service.
What documentation supports reporting this code?
The operative report should identify the esophagus-to-stomach reconstruction, the anatomy connected, and the role of the stomach in restoring continuity.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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.
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.
5,22143312,,Repair esophagus and fistula,A,,28.52,8.55,NA,8.55,,7.20,44.27,44.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22243313,,Esophagoplasty congenital,A,,47.24,21.21,NA,21.21,,12.66,81.11,81.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22343314,,Tracheo-esophagoplasty cong,A,,52.09,19.92,NA,19.92,,13.96,85.97,85.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22443320,,Fuse esophagus & stomach,A,,22.73,10.35,NA,10.35,,6.08,39.16,39.16,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22543325,,Revise esophagus & stomach,A,,22.04,10.18,NA,10.18,,5.89,38.11,38.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22643327,,Esoph fundoplasty lap,A,,13.02,7.20,NA,7.20,,3.47,23.69,23.69,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22743328,,Esoph fundoplasty thor,A,,19.41,7.48,NA,7.48,,4.88,31.77,31.77,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772