No office rate
Both codes cover laparoscopic paraesophageal hernia repair; choose 43282 when mesh is implanted and 43281 when it is not.
On this page
CMS RVU26D · Effective 2026-10-01
43281 Hernia repair Medicare reimbursement rates in Utah
Reports laparoscopic repair of a paraesophageal hernia without mesh, including fundoplasty when performed, for patients needing operative correction. Compare 43281 office and facility rates across CMS payment localities in Utah.
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 43281 in Utah?
Utah has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1381.91
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
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.
Digestive surgery
About 43281: Laparoscopic paraesophageal hernia repair without mesh
Reports laparoscopic repair of a paraesophageal hernia without mesh, including fundoplasty when performed, for patients needing operative correction.
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.
CMS billing rules for 43281
- 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 RVU25.94 · 61%
- Practice expense (office) RVU9.97 · 23%
- Malpractice RVU6.75 · 16%
16.9K
Medicare services in 2024 · #1211 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.
43281 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
43280 is for laparoscopic fundoplasty without paraesophageal hernia repair. Fundoplasty performed as part of the 43281 repair is included.
No office rate
43283 reports laparoscopic esophageal lengthening, not the hernia repair itself. It may be reported with 43281 when a distinct lengthening procedure is performed.
Compare 43281 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.
1 of 1 payment localities
Utah →
Office / nonfacility
Unavailable
Facility
$1381.91
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43281 in Utah.
PPRRVU2026_Oct_nonQPP.csv
5,205
- Code
- 43281
- Physician work
- 25.94
- Practice expense
- 9.97
- Malpractice
- 6.75
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 25.94 | × 1.000 | 25.9400 |
| Practice expense | 9.97 | × 0.940 | 9.3718 |
| Malpractice | 6.75 | × 0.898 | 6.0615 |
| Total RVUs | 41.3733 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$1381.91
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 25.94 | 1 |
| Practice expense | 9.97 | 0.94 |
| Malpractice | 6.75 | 0.898 |
(25.94 × 1 + 9.97 × 0.94 + 6.75 × 0.898) × $33.4009 = $1381.91
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 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.
5,20243278,,Ercp lesion ablate w/dilate,A,,7.72,2.68,NA,2.68,,0.87,11.27,11.27,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,20343279,,Lap myotomy heller,A,,21.55,8.79,NA,8.79,,5.58,35.92,35.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20443280,,Laparoscopy fundoplasty,A,,17.65,8.05,NA,8.05,,4.60,30.30,30.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20543281,,Lap paraesophag hern repair,A,,25.94,9.97,NA,9.97,,6.75,42.66,42.66,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20643282,,Lap paraesoph her rpr w/mesh,A,,29.35,10.91,NA,10.91,,7.70,47.96,47.96,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20743283,,Lap esoph lengthening,A,,2.88,0.64,NA,0.64,,0.73,4.25,4.25,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20843284,,Laps esophgl sphnctr agmntj,A,,9.88,6.25,NA,6.25,,2.63,18.76,18.76,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985