Billing code 43360: GI repairMedicare rate & RVUs in Utah
Reports operative repair of gastrointestinal tissue when the surgeon treats a defect or injury requiring surgical correction during a major procedure.
CMS doesn’t publish an office rate for 43360 in Utah.
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 43360 covers
billing code 43360 represents operative repair of gastrointestinal tissue. It is performed by a surgeon when a defect or injury requires direct surgical correction, rather than a diagnostic examination or a separately defined reconstruction. The operative report should identify the treated site, the nature of the defect or injury, the repair performed, and any associated procedures. Claims for this service are most commonly associated with facility surgery; CMS recorded facility services for this code in 2024.
This major surgery has a 90-day global period: the day-before preoperative visit and related postoperative care during the following 90 days are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. The operative note should support the distinct work and any separately reported procedures.
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.
43360 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $2,058.86 |
How the 43360 rate is calculated
Each of 43360’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 · 43360
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 39.11Practice expense 14.54Malpractice 9.87
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43360
43360 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43360
GI 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 · 43360
GI 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
43360 without 51 · national facility
$2,121.63
GI repair
43360-51 · Second procedure: 50%
$1,060.82
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%).
43360 compared with similar codes
Compare codes
43360 vs 43300 vs 43305 vs 43310 vs 43312: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43300Esophageal repair
- 43300 identifies a specific esophageal repair service. Choose it when the operative work matches that defined service rather than relying on the broader gastrointestinal repair label for 43360.
- 43305Esophageal repair
- 43305 describes esophageal repair that includes fistula repair. The operative report must support that additional work to distinguish it from 43360.
- 43310Esophageal repair
- 43310 is another specifically described esophageal repair option. Compare its full procedure definition with the documented anatomy and operative technique.
- 43312Esophageal repair
- 43312 describes esophageal repair with fistula repair. Use it when the operation includes that defined work, rather than selecting 43360 from a general description alone.
43360 billing questions
How should I distinguish 43360 from other gastrointestinal repair codes?
Use the operative report to identify the precise procedure and anatomy, then compare that work with the more specifically described esophageal repair options. Do not select 43360 based only on a general reference to gastrointestinal repair.
What documentation supports reporting 43360?
Document the site and nature of the defect or injury, the surgical repair performed, and any associated procedures. The operative report should make the work represented by this code clear.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care during the 90 days after surgery are included in the global period.
Can an assistant surgeon or co-surgeon be paid?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to reduction. The record should support each separately reported service.
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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