Billing code 43312: Esophageal repairMedicare rate & RVUs in Missouri
Reports open thoracic repair of an esophageal defect when the operation also closes a tracheoesophageal fistula.
CMS doesn’t publish an office rate for 43312 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 43312 covers
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.
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.
Where 43312 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | Unavailable | $1,455.71 |
| Metropolitan St. Louis | Unavailable | $1,465.43 |
| Rest Of Missouri | Unavailable | $1,433.00 |
How the 43312 rate is calculated
Each of 43312’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43312
RVUs × geographic indexes × conversion factor
Work28.52
28.52 RVUs× 1.000 GPCI
Practice expense8.55
8.55 RVUs× 1.000 GPCI
Malpractice7.20
7.20 RVUs× 1.000 GPCI
Adjusted RVUs
44.2700
Conversion factor
$33.4009
Medicare rate
$1,478.66
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43312
43312 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43312
Esophageal repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43312
Esophageal repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43312 without 51 · national facility
$1,478.66
Esophageal repair
43312-51 · Second procedure: 50%
$739.33
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43312 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43310Esophageal repair
- Use 43312 when the thoracic operation also repairs a tracheoesophageal fistula; 43310 describes thoracic esophageal repair without that fistula repair.
- 43305Esophageal repair
- Both include fistula repair, but 43305 uses a cervical approach. Choose based on the approach documented for the operation.
- 43300Esophageal repair
- 43300 is a cervical esophageal repair without fistula repair. This code involves a thoracic approach and includes fistula closure.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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