Billing code 43279: Heller myotomyMedicare rate & RVUs in Oregon
Reports laparoscopic division of the lower esophageal sphincter and distal esophageal muscle for achalasia, with fundoplasty included when performed.
CMS doesn’t publish an office rate for 43279 in Oregon.
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 43279 covers
This operation treats achalasia by laparoscopically dividing muscle at the lower esophageal sphincter and distal esophagus while preserving the esophageal lining. The surgeon may add a fundoplasty to help limit reflux. It is typically performed by a general or foregut surgeon in a hospital operating room for patients with impaired esophageal emptying and symptoms such as dysphagia.
Report 43279 for the laparoscopic Heller myotomy; fundoplasty performed during the operation is included, so do not separately report 43280 for that same wrap. The operative report should support the laparoscopic approach, myotomy, clinical indication, and whether fundoplasty was performed. CMS 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. Assistant-at-surgery payment may be made; co-surgeon payment requires 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 43279 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,196.15 |
| Rest Of Oregon | Unavailable | $1,143.23 |
How the 43279 rate is calculated
Each of 43279’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 · 43279
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.55Practice expense 8.79Malpractice 5.58
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43279
43279 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43279
Heller myotomy
| 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 · 43279
Heller myotomy
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
43279 without 51 · national facility
$1,199.76
Heller myotomy
43279-51 · Second procedure: 50%
$599.88
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%).
43279 compared with similar codes
Compare codes
43279 vs 43280 vs 43330 vs 43331: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43280Fundoplasty
- 43279 includes the laparoscopic Heller myotomy and any fundoplasty performed. 43280 is for fundoplasty without that myotomy.
- 43330Esophageal myotomy
- Both describe a Heller myotomy, but 43330 is the abdominal approach; 43279 is laparoscopic.
- 43331Esophageal myotomy
- 43331 describes a thoracic Heller approach. Choose 43279 when the myotomy is performed laparoscopically.
43279 billing questions
When should 43279 be chosen instead of 43280?
Use 43279 for a laparoscopic Heller myotomy, whether or not fundoplasty is performed. Code 43280 describes fundoplasty without the Heller myotomy.
Can the fundoplasty be billed separately?
No. Fundoplasty performed as part of the laparoscopic Heller operation is included in 43279; do not separately report 43280 for that same work.
Does modifier 50 apply?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports reporting 43279?
The operative report should identify the laparoscopic approach and Heller myotomy, document the achalasia-related indication, and state whether fundoplasty was performed.
How are assistant and co-surgeon claims handled?
Assistant-at-surgery payment may be made. 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.
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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