Billing code 43281: Hernia repairMedicare rate & RVUs in Texas
Reports laparoscopic repair of a paraesophageal hernia without mesh, including fundoplasty when performed, for patients needing operative correction.
CMS doesn’t publish an office rate for 43281 in Texas.
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 43281 covers
The surgeon repairs a paraesophageal hernia through laparoscopic access, returning herniated stomach or other contents to the abdomen and repairing the opening at the diaphragm. The operation may include fundoplasty as part of the repair. General surgeons and foregut surgeons commonly perform it in a hospital operating room for symptomatic or otherwise surgically managed paraesophageal hernias.
Report 43281 when the repair is laparoscopic and mesh is not implanted. If mesh is implanted, use 43282 instead. Fundoplasty performed as part of the hernia repair is included; do not separately report 43280 for that work. The operative report should establish the paraesophageal hernia, laparoscopic approach, repair performed, and whether mesh was implanted. Medicare 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 the standard multiple-procedure reduction. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation. 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 43281 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $1,420.23 |
| Beaumont | Unavailable | $1,378.90 |
| Brazoria | Unavailable | $1,379.22 |
| Dallas | Unavailable | $1,399.33 |
| Fort Worth | Unavailable | $1,398.93 |
| Galveston | Unavailable | $1,390.70 |
| Houston | Unavailable | $1,514.25 |
| Rest Of Texas | Unavailable | $1,386.03 |
How the 43281 rate is calculated
Each of 43281’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 · 43281
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 25.94Practice expense 9.97Malpractice 6.75
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43281
43281 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43281
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 · 43281
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
43281 without 51 · national facility
$1,424.88
Hernia repair
43281-51 · Second procedure: 50%
$712.44
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%).
43281 compared with similar codes
Compare codes
43281 vs 43282 vs 43280 vs 43283: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43282Hernia repair
- Both codes cover laparoscopic paraesophageal hernia repair; choose 43282 when mesh is implanted and 43281 when it is not.
- 43280Fundoplasty
- 43280 is for laparoscopic fundoplasty without paraesophageal hernia repair. Fundoplasty performed as part of the 43281 repair is included.
- 43283Esophageal lengthening
- 43283 reports laparoscopic esophageal lengthening, not the hernia repair itself. It may be reported with 43281 when a distinct lengthening procedure is performed.
43281 billing questions
How does 43281 differ from 43282?
Use 43281 for laparoscopic paraesophageal hernia repair without implanted mesh. Use 43282 when mesh is implanted.
Can fundoplasty be billed separately with 43281?
Fundoplasty performed as part of the paraesophageal hernia repair is included in 43281. Do not separately report 43280 for that fundoplasty.
Can 43281 be reported with laparoscopic esophageal lengthening?
43283 may be reported with the hernia repair when esophageal lengthening, such as a Collis gastroplasty, is performed for a shortened esophagus. The operative report should support the distinct lengthening procedure.
What documentation supports 43281?
Document the paraesophageal hernia, the laparoscopic repair, the work performed, and whether mesh was implanted. The record should also make clear whether fundoplasty was part of the repair.
What is included in the Medicare global period?
43281 has a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be allowed. Co-surgeon payment requires supporting documentation, and 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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