No office rate
Choose 43330 for an abdominal approach and 43331 for a thoracic approach. The operative report establishes which route was used.
On this page
CMS RVU26D · Effective 2026-10-01
43330 Esophageal myotomy Medicare reimbursement rates in Indiana
An abdominal Heller-type myotomy divides the esophageal muscle to relieve achalasia-related obstruction and is reported for the abdominal operative approach. Compare 43330 office and facility rates across CMS payment localities in Indiana.
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 43330 in Indiana?
Indiana 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
$1128.56
1 of 1 localities have a supported rate.
Payment area: Indiana
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.
Esophageal surgery
About 43330: Abdominal esophageal myotomy
An abdominal Heller-type myotomy divides the esophageal muscle to relieve achalasia-related obstruction and is reported for the abdominal operative approach.
This operation divides the muscle layer of the lower esophagus through an abdominal approach to ease passage of food into the stomach. It is most commonly performed by a general or thoracic surgeon for achalasia when the lower esophageal sphincter fails to relax. The service is generally performed in a hospital operating room. A fundoplication may also be performed to reduce reflux after the muscle is divided; the operative report should identify each procedure actually completed.
Select this code for the abdominal approach, not a thoracic or laparoscopic myotomy. Documentation should establish the indication, approach, extent of the myotomy, and any additional procedure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this single midline operation. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43330
- 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 RVU21.64 · 58%
- Practice expense (office) RVU10.08 · 27%
- Malpractice RVU5.77 · 15%
23
Medicare services in 2024 · #5845 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.
43330 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
43279 describes laparoscopic Heller-type myotomy and includes fundoplasty when performed. Use 43330 for the abdominal approach represented by this code.
No office rate
43327 describes an esophagofundoplasty, not the abdominal muscle division used to treat achalasia. The procedures address different operative steps.
Compare 43330 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
Indiana →
Office / nonfacility
Unavailable
Facility
$1128.56
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 43330 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,228
- Code
- 43330
- Physician work
- 21.64
- Practice expense
- 10.08
- Malpractice
- 5.77
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.64 | × 1.000 | 21.6400 |
| Practice expense | 10.08 | × 0.927 | 9.3442 |
| Malpractice | 5.77 | × 0.486 | 2.8042 |
| Total RVUs | 33.7884 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$1128.56
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.64 | 1 |
| Practice expense | 10.08 | 0.927 |
| Malpractice | 5.77 | 0.486 |
(21.64 × 1 + 10.08 × 0.927 + 5.77 × 0.486) × $33.4009 = $1128.56
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.
43330 billing questions
How does 43330 differ from 43331?
43330 is for the abdominal approach; 43331 is for a thoracic approach. The operative report should support the route used.
When would 43279 be more appropriate?
Use 43279 for laparoscopic Heller-type esophagomyotomy. Its descriptor includes fundoplasty when performed, unlike this abdominal-approach code.
Is a fundoplication included in 43330?
Document whether a fundoplication was performed as a separate operative step. Do not infer a separately reportable service merely because a wrap commonly accompanies a Heller myotomy.
Can modifier 50 be used?
No. This is a single abdominal myotomy, not a procedure performed on paired sides.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care through the 90-day period.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.
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.
5,22543325,,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
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
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915