No office rate
Both use a transthoracic approach for paraesophageal hernia repair. Choose 43335 when mesh is used and 43334 when it is not.
On this page
CMS RVU26D · Effective 2026-10-01
43335 Hiatal hernia repair Medicare reimbursement rates in New Jersey
Reports transthoracic repair of a paraesophageal hiatal hernia using mesh, including fundoplication when performed as part of the repair. Compare 43335 office and facility rates across CMS payment localities in New Jersey.
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 43335 in New Jersey?
New Jersey 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
$1328.52–$1359.54
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.
General surgery
About 43335: Transthoracic paraesophageal hernia repair with mesh
Reports transthoracic repair of a paraesophageal hiatal hernia using mesh, including fundoplication when performed as part of the repair.
This code describes repair of a paraesophageal hiatal hernia through a thoracic approach with mesh reinforcement; fundoplication is included when performed as part of the repair. A thoracic or general surgeon typically performs the operation in a hospital operating room, often for a large or complex hernia requiring access through the chest. The operative report should establish the hernia being repaired, the transthoracic route, and mesh use.
Select this code for the thoracic approach with mesh, rather than the corresponding thoracic repair without mesh or an abdominal approach. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, CMS pays the highest-valued procedure in full and others at 50%. Report this as a single repair, not with modifier 50. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43335
- 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 RVU23.37 · 62%
- Practice expense (office) RVU8.26 · 22%
- Malpractice RVU5.88 · 16%
42
Medicare services in 2024 · #5468 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.
43335 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
This code is for the abdominal approach without mesh. The transthoracic approach with mesh is reported with 43335.
No office rate
This code is for abdominal-approach repair with mesh. The approach, not mesh use alone, distinguishes it from 43335.
Compare 43335 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
Northern Nj →
Office / nonfacility
Unavailable
Facility
$1359.54
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$1328.52
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
43335 billing questions
How does this differ from 43334?
Both describe transthoracic paraesophageal hernia repair; 43335 includes mesh, while 43334 is the corresponding repair without mesh. The operative report should support which was performed.
When should the abdominal-approach codes be considered?
Use the abdominal-approach family when the repair is performed through the abdomen. Codes 43332 and 43333 distinguish the abdominal approach without and with mesh, respectively.
Is fundoplication separately reported with this repair?
Fundoplication is included when performed as part of the paraesophageal hernia repair. The operative documentation should describe the repair and any fundoplication performed.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor and anatomy; report the repair as a single procedure rather than appending modifier 50.
What postoperative care is included?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
How are assistant and co-surgeon services handled?
An assistant at surgery may be paid. Co-surgeon payment requires 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.
5,23043332,,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
5,23643338,,Esoph lengthening,A,,2.15,0.42,NA,0.42,,0.53,3.10,3.10,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00