Billing code 43336: Hernia repairMedicare rate & RVUs in Texas
Open thoracoabdominal repair of a diaphragmatic hernia without mesh, reported when the surgeon uses combined chest and abdominal access.
CMS doesn’t publish an office rate for 43336 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 43336 covers
This code describes open repair of a diaphragmatic hernia through a thoracoabdominal approach, using access through both the chest and abdomen. General or thoracic surgeons may perform it in a hospital operating room for a hernia requiring this combined exposure. The repair is reported without mesh; the operative approach and whether mesh was used distinguish it from nearby options. A transabdominal repair of a paraesophageal hiatal hernia is a different service.
Select the code from the operative report’s documented hernia repair, access route, and use or absence of mesh. The report should support the diaphragmatic defect treated and the combined approach. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is not appropriate for this repair. Assistant-at-surgery payment may be available; 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 43336 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 | $1,359.73 |
| Beaumont | Unavailable | $1,320.98 |
| Brazoria | Unavailable | $1,321.42 |
| Dallas | Unavailable | $1,340.34 |
| Fort Worth | Unavailable | $1,339.97 |
| Galveston | Unavailable | $1,332.21 |
| Houston | Unavailable | $1,448.25 |
| Rest Of Texas | Unavailable | $1,327.64 |
How the 43336 rate is calculated
Each of 43336’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 · 43336
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 25.16Practice expense 9.34Malpractice 6.34
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43336
43336 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43336
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 · 43336
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
43336 without 51 · national facility
$1,364.09
Hernia repair
43336-51 · Second procedure: 50%
$682.05
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%).
43336 compared with similar codes
Compare codes
43336 vs 43337 vs 43334 vs 43332: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43337Diaphragmatic hernia repair
- The thoracoabdominal approach is shared, but 43337 is reported when mesh is used. This code describes repair without mesh.
- 43334Diaphragmatic hernia repair
- 43334 uses a transthoracic approach for diaphragmatic hernia repair without mesh. This code requires the combined thoracoabdominal approach.
- 43332Hiatal hernia repair
- 43332 describes transabdominal repair of a paraesophageal hiatal hernia without fundoplasty. This code describes thoracoabdominal repair of a diaphragmatic hernia.
43336 billing questions
How does this differ from 43337?
Both describe thoracoabdominal diaphragmatic hernia repair. This code is for repair without mesh; 43337 is the mesh version.
When would 43334 or 43335 be more appropriate?
Those codes describe diaphragmatic hernia repair through a transthoracic approach. Choose between them and this code based on the operative approach documented.
Is a paraesophageal hiatal hernia repair reported with this code?
Not when the documented service is a transabdominal paraesophageal hiatal hernia repair. Codes 43332 and 43333 describe that different service.
What documentation supports this code?
The operative report should establish the diaphragmatic hernia treated, the thoracoabdominal approach, and that mesh was not used.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the 90-day global period affect postoperative services?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the global surgery payment.
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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