No office rate
Both use thoracoabdominal access for diaphragmatic hernia repair. Choose 43337 when mesh or another prosthesis reinforces the repair; choose 43336 when it does not.
On this page
CMS RVU26D · Effective 2026-10-01
43337 Diaphragmatic hernia repair Medicare reimbursement rates in New Mexico
Reports open repair of a non-neonatal diaphragmatic hernia through combined chest and abdominal access when mesh or another prosthesis reinforces the repair. Compare 43337 office and facility rates across CMS payment localities in New Mexico.
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 43337 in New Mexico?
New Mexico 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
$1469.56
1 of 1 localities have a supported rate.
Payment area: New Mexico
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.
Surgical repair
About 43337: Thoracoabdominal diaphragmatic hernia repair with mesh
Reports open repair of a non-neonatal diaphragmatic hernia through combined chest and abdominal access when mesh or another prosthesis reinforces the repair.
This code represents open repair of a diaphragmatic hernia using an approach that enters both the chest and abdomen, with mesh or another prosthetic material used to reinforce the defect. The surgeon reduces herniated abdominal contents and repairs the diaphragm; the combined access may be selected for a defect that requires exposure from both cavities. The service is performed in an operating room, typically by a surgeon treating a complex diaphragmatic defect in a hospital setting.
Select this code when the operative report supports the thoracoabdominal route and documents placement of mesh or another prosthesis; a thoracoabdominal repair without prosthetic reinforcement is represented by a related code. The 90-day global period includes the day-before preoperative visit and 90 days of 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-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43337
- 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 RVU26.96 · 62%
- Practice expense (office) RVU9.70 · 22%
- Malpractice RVU6.78 · 16%
17
Medicare services in 2024 · #6009 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.
43337 compared with similar codes
Office rates for New Mexico, from the same CMS release.
No office rate
Both include prosthetic reinforcement, but 43335 uses a transthoracic approach. 43337 requires thoracoabdominal access.
No office rate
43333 addresses paraesophageal hernia repair through an abdominal approach. 43337 is for diaphragmatic hernia repair through combined chest and abdominal access.
Compare 43337 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
New Mexico →
Office / nonfacility
Unavailable
Facility
$1469.56
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.
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 43337 in New Mexico.
PPRRVU2026_Oct_nonQPP.csv
5,235
- Code
- 43337
- Physician work
- 26.96
- Practice expense
- 9.70
- Malpractice
- 6.78
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 26.96 | × 1.000 | 26.9600 |
| Practice expense | 9.70 | × 0.917 | 8.8949 |
| Malpractice | 6.78 | × 1.201 | 8.1428 |
| Total RVUs | 43.9977 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, New Mexico$1469.56
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 26.96 | 1 |
| Practice expense | 9.7 | 0.917 |
| Malpractice | 6.78 | 1.201 |
(26.96 × 1 + 9.7 × 0.917 + 6.78 × 1.201) × $33.4009 = $1469.56
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.
43337 billing questions
How is this code distinguished from 43336?
Both describe diaphragmatic hernia repair through thoracoabdominal access. Use 43337 when the repair includes mesh or another prosthetic material; 43336 represents the repair without that reinforcement.
When is a thoracoabdominal approach appropriate?
The operative report must support access through both the chest and abdomen for the diaphragmatic hernia repair. Do not select this code solely because the hernia is large or complex.
Can modifier 50 be reported?
No. The anatomy and service do not support a bilateral adjustment.
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.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does payment change when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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.
5,23243334,,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
5,23743340,,Fuse esophagus & intestine,A,,22.42,10.27,NA,10.27,,6.00,38.69,38.69,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,23843341,,Fuse esophagus & intestine,A,,23.62,10.47,NA,10.47,,5.96,40.05,40.05,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068
7612402,NJ,99,REST OF NEW JERSEY,1.040,1.092,1.097
7704212,NM,05,NEW MEXICO,1.000,0.917,1.201
7813202,NY,01,MANHATTAN,1.064,1.162,1.586
7913202,NY,02,NYC SUBURBS/LONG ISLAND,1.064,1.189,1.857
8013202,NY,03,POUGHKPSIE/N NYC SUBURBS,1.045,1.095,1.210