No office rate
Both describe transthoracic diaphragmatic hernia repair; 43335 is the corresponding choice when mesh or another prosthesis is implanted.
On this page
CMS RVU26D · Effective 2026-10-01
43334 Diaphragmatic hernia repair Medicare reimbursement rates in Indiana
Reports transthoracic repair of a non-neonatal diaphragmatic hernia when the operation uses no mesh or other prosthesis. Compare 43334 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 43334 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
$1053.84
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.
Hernia surgery
About 43334: Transthoracic diaphragmatic hernia repair
Reports transthoracic repair of a non-neonatal diaphragmatic hernia when the operation uses no mesh or other prosthesis.
This code describes operative repair of a diaphragmatic hernia through a transthoracic approach, without mesh or another prosthesis. Thoracic or general surgeons may perform it in a hospital operating room for a diaphragmatic defect requiring repair through the chest. The operative report should identify the hernia and document the transthoracic route and whether prosthetic material was implanted; a repair using mesh belongs to the corresponding mesh code, 43335.
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and applies a 50% reduction to the others. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43334
- 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 RVU21.57 · 62%
- Practice expense (office) RVU7.91 · 23%
- Malpractice RVU5.45 · 16%
131
Medicare services in 2024 · #4660 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.
43334 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
43334 uses a transthoracic approach. Choose 43336 when the documented repair uses a thoracoabdominal approach and no prosthesis is implanted.
No office rate
43332 is for transabdominal repair of a paraesophageal hiatal hernia. 43334 is for a diaphragmatic hernia repaired through the chest.
Compare 43334 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
$1053.84
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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 43334 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,232
- Code
- 43334
- Physician work
- 21.57
- Practice expense
- 7.91
- Malpractice
- 5.45
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.57 | × 1.000 | 21.5700 |
| Practice expense | 7.91 | × 0.927 | 7.3326 |
| Malpractice | 5.45 | × 0.486 | 2.6487 |
| Total RVUs | 31.5513 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$1053.84
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.57 | 1 |
| Practice expense | 7.91 | 0.927 |
| Malpractice | 5.45 | 0.486 |
(21.57 × 1 + 7.91 × 0.927 + 5.45 × 0.486) × $33.4009 = $1053.84
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.
43334 billing questions
How is 43334 distinguished from 43335?
Use 43334 when the transthoracic repair is performed without mesh or another prosthesis. Use 43335 when prosthetic material is implanted.
When should 43336 be considered instead?
43336 describes repair through a thoracoabdominal approach without prosthetic material. The operative report should support the approach actually used.
Is modifier 50 appropriate for this repair?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
What postoperative care is included?
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 reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Medicare pays the highest-valued procedure in full and reduces the other procedure or procedures by 50% under the standard multiple procedure rule.
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.
5,22943331,,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
5,23443336,,Thorabd diaphr hern repair,A,,25.16,9.34,NA,9.34,,6.34,40.84,40.84,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23543337,,Thorabd diaphr hern repair,A,,26.96,9.70,NA,9.70,,6.78,43.44,43.44,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,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