Billing code 43361: GI repairMedicare rate & RVUs in Utah
Reports major operative repair in the esophageal gastrointestinal surgery family, with selection based on the specific repair performed and operative circumstances.
CMS doesn’t publish an office rate for 43361 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 43361 covers
This code represents a major surgical repair in the esophageal gastrointestinal surgery family. A surgeon typically performs the service in a hospital operating room to correct an operative defect or injury involving the gastrointestinal tract. The operative report should identify the anatomy repaired, the problem addressed, and the repair actually performed; the code should reflect that specific procedure rather than a general description of gastrointestinal surgery.
Report the code for the documented service, distinguishing it from other esophageal repairs by the procedure details and any associated condition or reconstruction. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. 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.
43361 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $2,429.79 |
How the 43361 rate is calculated
Each of 43361’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 · 43361
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 44.54Practice expense 18.60Malpractice 11.94
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43361
43361 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43361
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 · 43361
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
43361 without 51 · national facility
$2,507.74
GI repair
43361-51 · Second procedure: 50%
$1,253.87
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%).
43361 compared with similar codes
Compare codes
43361 vs 43300 vs 43305 vs 43360: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43300Esophageal repair
- Both are esophageal repair-family codes. Compare the documented repair and operative details rather than choosing by the general term repair alone.
- 43305Esophageal repair
- This related code is associated with repair involving a fistula. Use the code that matches whether the documented service includes that condition.
- 43360GI repair
- This neighboring code also has a gastrointestinal repair descriptor. Distinguish the codes using the specific procedure documented in the operative report.
43361 billing questions
How should this code be distinguished from other esophageal repair codes?
Use the code that matches the specific repair documented in the operative report. The anatomy, operative objective, and any associated fistula or reconstruction help distinguish related esophageal procedures.
Are related postoperative visits separately reported?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
How does the multiple-procedure rule affect payment?
When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What operative documentation supports reporting this code?
Document the gastrointestinal anatomy treated, the condition or defect addressed, and the repair performed. The operative details should support choosing this code over other esophageal repair procedures.
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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