No office rate
Both codes involve esophageal repair with fistula closure. Use the complete descriptors and operative report to identify which code matches the documented procedure and approach.
On this page
CMS RVU26D · Effective 2026-10-01
43305 Esophageal repair Medicare reimbursement rates in Nebraska
Reports operative repair of the esophagus together with closure of an associated fistula, such as a tracheoesophageal connection, during the same procedure. Compare 43305 office and facility rates across CMS payment localities in Nebraska.
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 43305 in Nebraska?
Nebraska 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
$869.35
1 of 1 localities have a supported rate.
Payment area: Nebraska
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.
Digestive surgery
About 43305: Esophageal repair with fistula closure
Reports operative repair of the esophagus together with closure of an associated fistula, such as a tracheoesophageal connection, during the same procedure.
A surgeon repairs the esophagus and closes an associated fistula, commonly a tracheoesophageal communication. This may be performed for a congenital abnormal connection or another surgically treated esophageal-fistula condition. The operative report should identify the esophageal defect, the fistula repaired, and the surgical approach. This is an operative service, generally performed in a hospital or other surgical facility.
Choose this code when the documented operation includes both esophageal repair and fistula closure; use the full code descriptor and operative details to distinguish it from related esophageal repair codes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43305
- 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 · 62%
- Practice expense (office) RVU8.02 · 28%
- Malpractice RVU2.58 · 9%
69
Medicare services in 2024 · #5155 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.
43305 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
This is a nearby esophageal repair code. Check whether the operation includes fistula closure and compare the full descriptor before selecting between the codes.
No office rate
This code describes congenital esophagoplasty. Choose it when that congenital esophageal reconstruction procedure, rather than the repair represented by 43305, is documented.
Compare 43305 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
Nebraska →
Office / nonfacility
Unavailable
Facility
$869.35
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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 43305 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
5,218
- Code
- 43305
- Physician work
- 17.65
- Practice expense
- 8.02
- Malpractice
- 2.58
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.65 | × 1.000 | 17.6500 |
| Practice expense | 8.02 | × 0.923 | 7.4025 |
| Malpractice | 2.58 | × 0.378 | 0.9752 |
| Total RVUs | 26.0277 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nebraska$869.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.65 | 1 |
| Practice expense | 8.02 | 0.923 |
| Malpractice | 2.58 | 0.378 |
(17.65 × 1 + 8.02 × 0.923 + 2.58 × 0.378) × $33.4009 = $869.35
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.
43305 billing questions
How is this code distinguished from 43312?
Both descriptors concern esophageal repair with fistula repair. Check the complete code descriptors and operative report for the distinction, including the documented surgical approach.
Can the fistula closure be billed separately?
When fistula closure is part of the esophageal repair reported with this code, it is included in that service. The operative report should support both elements of the coded procedure.
Should modifier 50 be appended for a fistula involving paired structures?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
5,21543290,,Egd flx trnsorl dplmnt balo,A,,3.03,76.51,,1.32,,0.36,79.90,4.71,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,21643291,,Egd flx trnsorl rmvl balo,A,,2.73,12.14,,1.23,,0.30,15.17,4.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,21743300,,Repair of esophagus,A,,9.10,6.10,NA,6.10,,1.32,16.52,16.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21843305,,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
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068