No office rate
Use 43312 when the thoracic operation also repairs a tracheoesophageal fistula; 43310 describes thoracic esophageal repair without that fistula repair.
On this page
CMS RVU26D · Effective 2026-10-01
43312 Esophageal repair Medicare reimbursement rates in Maine
Reports open thoracic repair of an esophageal defect when the operation also closes a tracheoesophageal fistula. Compare 43312 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 43312 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
$1364.91–$1387.35
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.
Esophageal surgery
About 43312: Thoracic esophageal repair with fistula closure
Reports open thoracic repair of an esophageal defect when the operation also closes a tracheoesophageal fistula.
This operation repairs an esophageal defect through a thoracic approach and closes a communication between the esophagus and trachea. It may be used for a tracheoesophageal fistula associated with congenital disease or one acquired after injury, surgery, or prolonged airway instrumentation. A thoracic or general surgeon typically performs the repair in an operating room, often with anesthesia and other surgical support.
Select this code when the operative report documents both the thoracic approach and repair of the fistula, not merely an esophageal repair without fistula closure. Documentation should identify the fistula and describe its closure as part of the operation. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 43312
- 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 RVU28.52 · 64%
- Practice expense (office) RVU8.55 · 19%
- Malpractice RVU7.20 · 16%
16
Medicare services in 2024 · #6038 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.
43312 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
Both include fistula repair, but 43305 uses a cervical approach. Choose based on the approach documented for the operation.
No office rate
43300 is a cervical esophageal repair without fistula repair. This code involves a thoracic approach and includes fistula closure.
Compare 43312 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
$1364.91
Southern Maine →
Office / nonfacility
Unavailable
Facility
$1387.35
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43312 billing questions
How does this differ from 43310?
Both involve a thoracic approach, but 43312 includes repair of a tracheoesophageal fistula. Use 43310 when the thoracic esophageal repair does not include fistula repair.
How does this differ from 43305?
Both include fistula repair, but 43305 is the cervical-approach counterpart. The operative report should support the approach used.
Can the fistula closure be reported separately?
The fistula repair is part of this service. Do not report a separate code for the same fistula-closure work.
Does Medicare apply a 90-day global period?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Should modifier 50 be used for a fistula on each side?
No. Medicare's bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
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.
5,21843305,,Repair esophagus and fistula,A,,17.65,8.02,NA,8.02,,2.58,28.25,28.25,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2194330F,,Cnslng epi spec sfty issues,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22043310,,Repair of esophagus,A,,25.60,9.89,NA,9.89,,6.44,41.93,41.93,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22143312,,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