Billing code 43313: Esophageal repairMedicare rate & RVUs in Texas
Reports surgical reconstruction for congenital esophageal atresia, with or without repair of an associated tracheoesophageal fistula.
CMS doesn’t publish an office rate for 43313 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 43313 covers
This code describes an operation to restore esophageal continuity for a congenital defect such as esophageal atresia. The repair may also address an associated tracheoesophageal fistula. Pediatric surgeons and other surgeons experienced in esophageal reconstruction typically perform it in a hospital operating room, often for a newborn or infant with a congenital esophageal anomaly.
Select this code when the operative service is congenital esophageal reconstruction, rather than repair of an acquired esophageal defect or a procedure focused on the trachea and esophagus. The operative report should establish the congenital condition and describe the reconstruction and any fistula repair. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment may be made; 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.
Where 43313 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 | $2,705.19 |
| Beaumont | Unavailable | $2,615.37 |
| Brazoria | Unavailable | $2,622.37 |
| Dallas | Unavailable | $2,660.47 |
| Fort Worth | Unavailable | $2,658.88 |
| Galveston | Unavailable | $2,644.08 |
| Houston | Unavailable | $2,875.80 |
| Rest Of Texas | Unavailable | $2,632.00 |
How the 43313 rate is calculated
Each of 43313’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 · 43313
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 47.24Practice expense 21.21Malpractice 12.66
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43313
43313 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43313
Esophageal 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 · 43313
Esophageal 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
43313 without 51 · national facility
$2,709.15
Esophageal repair
43313-51 · Second procedure: 50%
$1,354.58
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%).
43313 compared with similar codes
Compare codes
43313 vs 43314 vs 43312 vs 43300: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43314Tracheoesophageal repair
- 43313 centers on congenital esophageal reconstruction, including atresia repair. 43314 centers on congenital reconstruction involving the trachea and esophagus.
- 43312Esophageal repair
- 43312 describes esophageal repair with fistula repair; 43313 is specifically for congenital esophageal reconstruction, with or without fistula repair.
- 43300Esophageal repair
- 43300 describes esophageal repair outside the congenital reconstruction service represented by 43313.
43313 billing questions
When should 43313 be selected instead of 43314?
Use 43313 when the operation is centered on congenital esophageal reconstruction, including repair of esophageal atresia. Code 43314 describes congenital reconstruction focused on the trachea and esophagus.
Is repair of an associated tracheoesophageal fistula separately reported?
When fistula repair is performed as part of the congenital esophageal reconstruction, it is included in 43313. The code covers the congenital reconstruction with or without that repair.
How does 43313 differ from 43312?
43313 is for congenital esophageal reconstruction. Consider 43312 for an esophageal repair involving a fistula when the service is not the congenital reconstruction described by 43313.
What documentation supports reporting 43313?
The operative report should identify the congenital esophageal condition and describe the reconstruction performed, including whether an associated fistula was repaired.
Can an assistant or co-surgeon be reported?
CMS allows assistant-at-surgery payment for 43313. 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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