No office rate
Choose 43300 when the esophageal repair is performed through a cervical approach. 43310 is the thoracic-approach repair without fistula repair.
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CMS RVU26D · Effective 2026-10-01
43310 Esophageal repair Medicare reimbursement rates in Texas
Reports surgical repair of an esophageal injury or defect through a thoracic approach when the operation does not include tracheoesophageal fistula repair. Compare 43310 office and facility rates across CMS payment localities in Texas.
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 43310 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
No 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.
Where 43310 pays more and less in Texas
Esophageal surgery
About 43310: Thoracic esophageal repair without fistula repair
Reports surgical repair of an esophageal injury or defect through a thoracic approach when the operation does not include tracheoesophageal fistula repair.
This code describes operative repair of an esophageal defect reached through the chest, without repair of a tracheoesophageal fistula. Thoracic or general surgeons may use it for a perforation or other esophageal injury requiring surgical closure or reconstruction. The operative report should establish the thoracic route and describe the defect and repair; an esophageal injury treated through a cervical approach belongs to a different code in this family.
Select the code based on the documented approach and whether a tracheoesophageal fistula is repaired, not simply on the diagnosis of an esophageal perforation. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For other procedures performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this single esophageal repair. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 43310
- 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 RVU25.60 · 61%
- Practice expense (office) RVU9.89 · 24%
- Malpractice RVU6.44 · 15%
14
Medicare services in 2024 · #6101 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.
43310 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
43305 describes cervical-approach repair with tracheoesophageal fistula repair. For a thoracic approach with fistula repair, compare 43312.
No office rate
Both codes describe thoracic-approach repair; 43312 includes repair of a tracheoesophageal fistula, while 43310 does not.
Compare 43310 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office Unavailable | Facility $1396.85 |
| Beaumont | Office Unavailable | Facility $1355.50 |
| Brazoria | Office Unavailable | Facility $1357.04 |
| Dallas | Office Unavailable | Facility $1376.33 |
| Fort Worth | Office Unavailable | Facility $1375.82 |
| Galveston | Office Unavailable | Facility $1368.03 |
| Houston | Office Unavailable | Facility $1485.91 |
| Rest Of Texas | Office Unavailable | Facility $1362.79 |
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43310 billing questions
How does 43310 differ from 43300?
43310 is for repair through a thoracic approach; 43300 is the corresponding repair through a cervical approach. The operative report must support the route used.
When should 43312 be used instead?
Use 43312 when the thoracic esophageal operation also repairs a tracheoesophageal fistula. 43310 describes thoracic repair without that fistula repair.
What documentation supports 43310?
The operative report should identify the esophageal defect, describe the repair, document the thoracic approach, and clarify whether a tracheoesophageal fistula was repaired.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this single esophageal repair.
How are assistant and co-surgeon services handled?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment 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.
5,21743300,,Repair of esophagus,A,,9.10,6.10,NA,6.10,,1.32,16.52,16.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21843305,,Repair esophagus and fistula,A,,17.65,8.02,NA,8.02,,2.58,28.25,28.25,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2194330F,,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