No office rate
Use 43284 for laparoscopic magnetic device placement. Use 43280 when the surgeon performs laparoscopic fundoplasty instead.
On this page
CMS RVU26D · Effective 2026-10-01
43284 Sphincter augmentation Medicare reimbursement rates in Vermont
Reports laparoscopic placement of a magnetic device around the lower esophageal sphincter to treat gastroesophageal reflux disease. Compare 43284 office and facility rates across CMS payment localities in Vermont.
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 43284 in Vermont?
Vermont 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
$581.12
1 of 1 localities have a supported rate.
Payment area: Vermont
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 43284: Laparoscopic magnetic sphincter augmentation
Reports laparoscopic placement of a magnetic device around the lower esophageal sphincter to treat gastroesophageal reflux disease.
A surgeon places a ring of magnetic beads around the lower esophagus at the lower esophageal sphincter. The device is intended to strengthen the barrier against reflux while allowing food and liquid to pass. This procedure is typically performed laparoscopically by a general or foregut surgeon in a hospital or ambulatory surgery setting for a patient with gastroesophageal reflux disease.
Report the service when the operative record supports laparoscopic placement of the sphincter augmentation device; documentation should identify the procedure and device placement. A separately performed paraesophageal hernia repair may be reported when supported by the operative work and documentation. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this procedure. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43284
- 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 RVU9.88 · 53%
- Practice expense (office) RVU6.25 · 33%
- Malpractice RVU2.63 · 14%
83
Medicare services in 2024 · #5020 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.
43284 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
This code describes laparoscopic paraesophageal hernia repair without mesh, not magnetic sphincter augmentation.
No office rate
This code describes laparoscopic paraesophageal hernia repair with mesh. It does not report placement of the magnetic augmentation device.
No office rate
43285 reports laparoscopic removal of an esophageal sphincter augmentation device; 43284 reports device placement.
Compare 43284 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
Vermont →
Office / nonfacility
Unavailable
Facility
$581.12
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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 43284 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,208
- Code
- 43284
- Physician work
- 9.88
- Practice expense
- 6.25
- Malpractice
- 2.63
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.88 | × 1.000 | 9.8800 |
| Practice expense | 6.25 | × 0.990 | 6.1875 |
| Malpractice | 2.63 | × 0.506 | 1.3308 |
| Total RVUs | 17.3983 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$581.12
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.88 | 1 |
| Practice expense | 6.25 | 0.99 |
| Malpractice | 2.63 | 0.506 |
(9.88 × 1 + 6.25 × 0.99 + 2.63 × 0.506) × $33.4009 = $581.12
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.
43284 billing questions
How is 43284 different from laparoscopic fundoplasty code 43280?
43284 reports placement of a magnetic sphincter augmentation device. Code 43280 reports laparoscopic fundoplasty, a different surgical approach to reflux treatment.
Can a paraesophageal hernia repair be reported with 43284?
A distinct repair may be reported when performed and documented in addition to device placement. Codes 43281 and 43282 distinguish repair without and with mesh, respectively.
Should modifier 50 be appended?
No. This procedure is not reported bilaterally, and modifier 50 is inappropriate.
What supports reporting 43284?
The operative report should establish the laparoscopic procedure and placement of the magnetic augmentation device. Documentation of a separate hernia repair should describe that additional operative work.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. The code also has a 90-day global period.
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.
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.
5,20543281,,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
5,20943285,,Rmvl esophgl sphnctr dev,A,,10.21,6.33,NA,6.33,,2.73,19.27,19.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21043286,,Esphg tot w/laps moblj,A,,53.63,20.84,NA,20.84,,13.71,88.18,88.18,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21143287,,Esphg dstl 2/3 w/laps moblj,A,,61.43,21.65,NA,21.65,,15.54,98.62,98.62,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817