No office rate
43279 includes the laparoscopic Heller myotomy and any fundoplasty performed. 43280 is for fundoplasty without that myotomy.
On this page
CMS RVU26D · Effective 2026-10-01
43279 Heller myotomy Medicare reimbursement rates in Rhode Island
Reports laparoscopic division of the lower esophageal sphincter and distal esophageal muscle for achalasia, with fundoplasty included when performed. Compare 43279 office and facility rates across CMS payment localities in Rhode Island.
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 43279 in Rhode Island?
Rhode Island 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
$1203.00
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Esophageal surgery
About 43279: Laparoscopic Heller myotomy with fundoplasty
Reports laparoscopic division of the lower esophageal sphincter and distal esophageal muscle for achalasia, with fundoplasty included when performed.
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.
CMS billing rules for 43279
- 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 RVU21.55 · 60%
- Practice expense (office) RVU8.79 · 24%
- Malpractice RVU5.58 · 16%
693
Medicare services in 2024 · #3273 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.
43279 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
Both describe a Heller myotomy, but 43330 is the abdominal approach; 43279 is laparoscopic.
No office rate
43331 describes a thoracic Heller approach. Choose 43279 when the myotomy is performed laparoscopically.
Compare 43279 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
Rhode Island →
Office / nonfacility
Unavailable
Facility
$1203.00
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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 43279 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,203
- Code
- 43279
- Physician work
- 21.55
- Practice expense
- 8.79
- Malpractice
- 5.58
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.55 | × 1.019 | 21.9595 |
| Practice expense | 8.79 | × 1.033 | 9.0801 |
| Malpractice | 5.58 | × 0.892 | 4.9774 |
| Total RVUs | 36.0169 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$1203.00
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.55 | 1.019 |
| Practice expense | 8.79 | 1.033 |
| Malpractice | 5.58 | 0.892 |
(21.55 × 1.019 + 8.79 × 1.033 + 5.58 × 0.892) × $33.4009 = $1203.00
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.
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 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.
5,20043276,,Ercp stent exchange w/dilate,A,,8.62,2.95,NA,2.95,,0.98,12.55,12.55,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,20143277,,Ercp ea duct/ampulla dilate,A,,6.73,2.40,NA,2.40,,0.75,9.88,9.88,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,20243278,,Ercp lesion ablate w/dilate,A,,7.72,2.68,NA,2.68,,0.87,11.27,11.27,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,20343279,,Lap myotomy heller,A,,21.55,8.79,NA,8.79,,5.58,35.92,35.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20443280,,Laparoscopy fundoplasty,A,,17.65,8.05,NA,8.05,,4.60,30.30,30.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20543281,,Lap paraesophag hern repair,A,,25.94,9.97,NA,9.97,,6.75,42.66,42.66,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20643282,,Lap paraesoph her rpr w/mesh,A,,29.35,10.91,NA,10.91,,7.70,47.96,47.96,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537