No office rate
Choose 43281 for laparoscopic paraesophageal hernia repair without mesh; its reported work includes fundoplasty when performed. Use 43280 for fundoplasty without that hernia repair.
On this page
CMS RVU26D · Effective 2026-10-01
43280 Fundoplasty Medicare reimbursement rates in Maine
A surgeon creates an antireflux wrap around the distal esophagus laparoscopically, typically for gastroesophageal reflux requiring operative treatment. Compare 43280 office and facility rates across CMS payment localities in Maine.
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 43280 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$932.46–$952.93
2 of 2 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.
Upper GI surgery
About 43280: Laparoscopic esophagogastric fundoplasty
A surgeon creates an antireflux wrap around the distal esophagus laparoscopically, typically for gastroesophageal reflux requiring operative treatment.
A surgeon uses laparoscopic access to wrap part of the stomach’s fundus around the lower esophagus, strengthening the barrier against reflux. Nissen and Toupet operations are examples of this approach. Foregut or general surgeons typically perform it in a hospital operating room for patients with gastroesophageal reflux requiring surgical treatment, sometimes in the setting of a hiatal defect that does not call for paraesophageal hernia repair coding.
Report the service when the operative documentation supports a laparoscopic fundoplasty as the principal procedure; include the indication and the technique performed. If the operation repairs a paraesophageal hernia, 43281 or 43282 may be the applicable code because fundoplasty is included when performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When 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% reduction. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 43280
- 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 RVU17.65 · 58%
- Practice expense (office) RVU8.05 · 27%
- Malpractice RVU4.60 · 15%
2.3K
Medicare services in 2024 · #2367 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.
43280 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
Choose 43282 for laparoscopic paraesophageal hernia repair with mesh; fundoplasty is included when performed. It is not a separate fundoplasty-only service.
No office rate
43279 treats achalasia with laparoscopic esophagomyotomy and includes fundoplasty when performed. 43280 describes the fundoplasty operation without that myotomy.
Compare 43280 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$932.46
Southern Maine →
Office / nonfacility
Unavailable
Facility
$952.93
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43280 billing questions
When should 43280 be chosen instead of 43281 or 43282?
Use 43280 for a laparoscopic fundoplasty without a separately coded paraesophageal hernia repair. Codes 43281 and 43282 describe paraesophageal hernia repair and include fundoplasty when performed; 43282 applies when mesh is used.
Can 43280 be reported with a paraesophageal hernia repair code?
Fundoplasty is included in 43281 and 43282 when performed, so do not separately report 43280 for that work.
What documentation supports 43280?
The operative report should establish laparoscopic access, the fundoplasty technique, and the clinical indication. It should also clarify whether the operation included paraesophageal hernia repair.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. This applies to care related to the fundoplasty.
How are other procedures in the same session affected?
The highest-valued procedure is paid in full, while other procedures performed in the same session are subject to the standard 50% multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with 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.
5,20143277,,Ercp ea duct/ampulla dilate,A,,6.73,2.40,NA,2.40,,0.75,9.88,9.88,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,20243278,,Ercp lesion ablate w/dilate,A,,7.72,2.68,NA,2.68,,0.87,11.27,11.27,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,20343279,,Lap myotomy heller,A,,21.55,8.79,NA,8.79,,5.58,35.92,35.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20443280,,Laparoscopy fundoplasty,A,,17.65,8.05,NA,8.05,,4.60,30.30,30.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20543281,,Lap paraesophag hern repair,A,,25.94,9.97,NA,9.97,,6.75,42.66,42.66,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20643282,,Lap paraesoph her rpr w/mesh,A,,29.35,10.91,NA,10.91,,7.70,47.96,47.96,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20743283,,Lap esoph lengthening,A,,2.88,0.64,NA,0.64,,0.73,4.25,4.25,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00