No office rate
Both address congenital esophageal surgery, but 43314 is the tracheoesophageal reconstruction code. Select 43313 when the documented service is the distinct congenital esophagoplasty represented by that code.
On this page
CMS RVU26D · Effective 2026-10-01
43314 Tracheoesophageal repair Medicare reimbursement rates in Pennsylvania
Operative reconstruction for a congenital tracheoesophageal abnormality, such as esophageal atresia with a tracheoesophageal fistula, is reported with this code. Compare 43314 office and facility rates across CMS payment localities in Pennsylvania.
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 43314 in Pennsylvania?
Pennsylvania 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
$2791.27–$3020.06
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 43314: Congenital tracheoesophageal reconstruction
Operative reconstruction for a congenital tracheoesophageal abnormality, such as esophageal atresia with a tracheoesophageal fistula, is reported with this code.
This code represents surgery to reconstruct the esophagus in a congenital tracheoesophageal condition. A canonical setting is repair of esophageal atresia with an associated tracheoesophageal fistula, usually performed by a pediatric surgeon or thoracic surgeon in an operating room. The operative work addresses the congenital connection or defect involving the esophagus and trachea; the operative report should make the congenital diagnosis and the reconstruction performed clear.
Report the code when the documented procedure matches congenital tracheoesophageal reconstruction, rather than an isolated congenital esophageal repair or a repair coded for a noncongenital fistula. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple 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. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43314
- 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 RVU52.09 · 61%
- Practice expense (office) RVU19.92 · 23%
- Malpractice RVU13.96 · 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.
43314 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
This code describes esophageal repair with fistula repair; 43314 is for congenital tracheoesophageal reconstruction. Base the choice on the congenital anatomy and procedure documented.
No office rate
This is another esophageal repair code involving fistula repair. It is not interchangeable with 43314 when the operative service reconstructs a congenital tracheoesophageal abnormality.
Compare 43314 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$3020.06
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$2791.27
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43314 billing questions
How is this different from 43313?
Use 43314 for congenital tracheoesophageal reconstruction, such as repair involving an associated tracheoesophageal fistula. Code 43313 is the nearby congenital esophagoplasty code for a different documented service.
Can this be reported with a separate fistula repair code?
The procedure may include repair of the congenital tracheoesophageal connection. Review the operative work before separately reporting another repair code, and do not separately represent work already included in the reconstruction.
What documentation supports reporting 43314?
The operative report should identify the congenital tracheoesophageal condition and describe the esophageal reconstruction and any associated fistula repair. A diagnosis alone does not establish which procedure was performed.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. CMS also applies the standard multiple procedure reduction when other procedures are performed in the same session.
May an assistant or co-surgeon be reported?
CMS indicates that 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.
5,22043310,,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
5,22643327,,Esoph fundoplasty lap,A,,13.02,7.20,NA,7.20,,3.47,23.69,23.69,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00