CPT code 43333: Hernia repair2026 Medicare rate & RVUs in Rhode Island
Reports abdominal-route repair of a paraesophageal hiatal hernia reinforced with mesh, including any fundoplasty performed as part of the operation.
CMS doesn’t publish an office rate for 43333 in Rhode Island.
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 43333 covers
Code 43333 represents operative repair of a paraesophageal hiatal hernia through an abdominal approach, with mesh reinforcement at the hiatus. The surgeon reduces herniated stomach or other displaced viscera from the chest and reconstructs the hiatus; fundoplasty may be performed as part of the repair. This major foregut operation is generally performed by a general or thoracic surgeon in a hospital operating room, often for a large hernia associated with obstructive symptoms, reflux, or risk of volvulus. The transabdominal route distinguishes it from transthoracic repair, while mesh distinguishes it from 43332.
Report 43333 when documentation establishes the paraesophageal hernia, transabdominal approach, and mesh use; describe the repair and any fundoplasty. Fundoplasty performed as part of the hernia operation is included rather than separately reported as a distinct service. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is inappropriate for this single hiatal repair. An assistant at surgery may be paid; 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.
43333 in Rhode Island
| Payment locality | Office | Facility |
|---|---|---|
| Rhode Island | Unavailable | $1,179.25 |
How the 43333 rate is calculated
Each of 43333’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 · 43333
RVUs × geographic indexes × conversion factor
Work20.92
20.92 RVUs× 1.000 GPCI
Practice expense8.87
8.87 RVUs× 1.000 GPCI
Malpractice5.41
5.41 RVUs× 1.000 GPCI
Adjusted RVUs
35.2000
Conversion factor
$33.4009
Medicare rate
$1,175.71
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43333
43333 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43333
Hernia repair
| 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 · 43333
Hernia repair
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
43333 without 51 · national facility
$1,175.71
Hernia repair
43333-51 · Second procedure: 50%
$587.86
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%).
43333 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43332Hiatal hernia repair
- Both use a transabdominal approach for paraesophageal hernia repair. Choose 43333 when mesh is used and 43332 when the repair is performed without mesh.
- 43282Hernia repair
- 43282 describes laparoscopic paraesophageal hernia repair with mesh. Code 43333 describes the transabdominal repair represented by this code, rather than the laparoscopic service.
- 43281Hernia repair
- 43281 is the laparoscopic repair without mesh. Code 43333 is the transabdominal repair with mesh.
- 43335Hiatal hernia repair
- Both include mesh reinforcement for paraesophageal hernia repair; 43335 identifies the transthoracic approach, while 43333 identifies the transabdominal approach.
43333 billing questions
How does 43333 differ from 43332?
Both describe transabdominal paraesophageal hernia repair. Use 43333 when mesh is used; 43332 is the corresponding repair without mesh.
Is fundoplasty separately reported with 43333?
Fundoplasty performed as part of the hernia repair is included in 43333. The operative report should identify the repair and describe any fundoplasty performed.
Can 43333 be reported for a laparoscopic repair?
The code identifies a transabdominal repair with mesh; laparoscopic paraesophageal hernia repair is represented by 43282. Choose the code that matches the documented approach.
Can modifier 50 be appended?
No. The hiatal repair is a single midline operation, so modifier 50 is inappropriate.
How are assistant and co-surgeon services handled?
An assistant at surgery may be paid for 43333. 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 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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