No office rate
43313 centers on congenital esophageal reconstruction, including atresia repair. 43314 centers on congenital reconstruction involving the trachea and esophagus.
On this page
CMS RVU26D · Effective 2026-10-01
43313 Esophageal repair Medicare reimbursement rates in Oregon
Reports surgical reconstruction for congenital esophageal atresia, with or without repair of an associated tracheoesophageal fistula. Compare 43313 office and facility rates across CMS payment localities in Oregon.
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 43313 in Oregon?
Oregon 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
$2580.73–$2704.78
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.
Esophageal surgery
About 43313: Congenital esophageal reconstruction
Reports surgical reconstruction for congenital esophageal atresia, with or without repair of an associated tracheoesophageal fistula.
This code describes an operation to restore esophageal continuity for a congenital defect such as esophageal atresia. The repair may also address an associated tracheoesophageal fistula. Pediatric surgeons and other surgeons experienced in esophageal reconstruction typically perform it in a hospital operating room, often for a newborn or infant with a congenital esophageal anomaly.
Select this code when the operative service is congenital esophageal reconstruction, rather than repair of an acquired esophageal defect or a procedure focused on the trachea and esophagus. The operative report should establish the congenital condition and describe the reconstruction and any fistula repair. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43313
- 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 RVU47.24 · 58%
- Practice expense (office) RVU21.21 · 26%
- Malpractice RVU12.66 · 16%
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.
43313 compared with similar codes
Office rates for Oregon, from the same CMS release.
No office rate
43312 describes esophageal repair with fistula repair; 43313 is specifically for congenital esophageal reconstruction, with or without fistula repair.
No office rate
43300 describes esophageal repair outside the congenital reconstruction service represented by 43313.
Compare 43313 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
Portland →
Office / nonfacility
Unavailable
Facility
$2704.78
Rest Of Oregon →
Office / nonfacility
Unavailable
Facility
$2580.73
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43313 billing questions
When should 43313 be selected instead of 43314?
Use 43313 when the operation is centered on congenital esophageal reconstruction, including repair of esophageal atresia. Code 43314 describes congenital reconstruction focused on the trachea and esophagus.
Is repair of an associated tracheoesophageal fistula separately reported?
When fistula repair is performed as part of the congenital esophageal reconstruction, it is included in 43313. The code covers the congenital reconstruction with or without that repair.
How does 43313 differ from 43312?
43313 is for congenital esophageal reconstruction. Consider 43312 for an esophageal repair involving a fistula when the service is not the congenital reconstruction described by 43313.
What documentation supports reporting 43313?
The operative report should identify the congenital esophageal condition and describe the reconstruction performed, including whether an associated fistula was repaired.
Can an assistant or co-surgeon be reported?
CMS allows assistant-at-surgery payment for 43313. 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.
5,2194330F,,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
5,22243313,,Esophagoplasty congenital,A,,47.24,21.21,NA,21.21,,12.66,81.11,81.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22343314,,Tracheo-esophagoplasty cong,A,,52.09,19.92,NA,19.92,,13.96,85.97,85.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22443320,,Fuse esophagus & stomach,A,,22.73,10.35,NA,10.35,,6.08,39.16,39.16,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,22543325,,Revise esophagus & stomach,A,,22.04,10.18,NA,10.18,,5.89,38.11,38.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00