No office rate
Choose 43333 rather than 43332 when fundoplasty is performed during the open transabdominal repair; both codes describe repairs without mesh.
On this page
CMS RVU26D · Effective 2026-10-01
43332 Hiatal hernia repair Medicare reimbursement rates in Illinois
Reports open abdominal repair of a paraesophageal hiatal hernia when the operation does not include fundoplasty or mesh implantation. Compare 43332 office and facility rates across CMS payment localities in Illinois.
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 43332 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1145.61–$1294.78
4 of 4 localities have a supported rate.
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.
Where 43332 pays more and less in Illinois
Gastrointestinal surgery
About 43332: Open transabdominal paraesophageal hernia repair
Reports open abdominal repair of a paraesophageal hiatal hernia when the operation does not include fundoplasty or mesh implantation.
This code describes an open abdominal operation to repair a paraesophageal hiatal hernia. The surgeon brings herniated stomach or other displaced contents back into the abdomen and repairs the enlarged opening in the diaphragm. General and foregut surgeons commonly perform the procedure in a hospital operating room. The code distinguishes a repair performed without fundoplasty and without mesh from related approaches and repairs that include those features.
Report the code when the operative report supports the transabdominal approach and confirms that neither fundoplasty nor mesh implantation was performed. Documentation should describe the hernia repair and the operative approach; use a related code when the operation includes a different approach, fundoplasty, or mesh. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure setting, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this repair.
CMS billing rules for 43332
- 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 RVU19.13 · 59%
- Practice expense (office) RVU8.26 · 26%
- Malpractice RVU4.88 · 15%
539
Medicare services in 2024 · #3490 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.
43332 compared with similar codes
Office rates for Illinois, from the same CMS release.
No office rate
43334 identifies a transthoracic repair without fundoplasty or mesh. 43332 identifies the transabdominal approach.
No office rate
43281 is the laparoscopic alternative for paraesophageal hernia repair without mesh; 43332 is for an open transabdominal operation.
No office rate
43282 describes laparoscopic paraesophageal hernia repair with mesh implantation. 43332 describes an open abdominal repair without mesh.
Compare 43332 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
Unavailable
Facility
$1294.78
East St. Louis →
Office / nonfacility
Unavailable
Facility
$1221.05
Rest Of Illinois →
Office / nonfacility
Unavailable
Facility
$1145.61
Suburban Chicago →
Office / nonfacility
Unavailable
Facility
$1215.60
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43332 billing questions
How does 43332 differ from 43333?
43332 is for the open transabdominal repair without fundoplasty or mesh. Use 43333 when the repair includes fundoplasty and does not include mesh.
Can 43332 be used for a laparoscopic repair?
No. It identifies an open transabdominal approach. Laparoscopic paraesophageal hernia repair is represented by a different code family.
What operative details should the record support?
Document the paraesophageal hernia repair, the transabdominal approach, and whether fundoplasty or mesh was performed. Those details distinguish this code from related repair options.
Does modifier 50 apply when the hernia involves both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. 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.
5,22743328,,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
5,22843330,,Esophagomyotomy abdominal,A,,21.64,10.08,NA,10.08,,5.77,37.49,37.49,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22943331,,Esophagomyotomy thoracic,A,,22.48,10.25,NA,10.25,,5.66,38.39,38.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23043332,,Transab esoph hiat hern rpr,A,,19.13,8.26,NA,8.26,,4.88,32.27,32.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23143333,,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