No office rate
Both are esophageal repair-family codes. Compare the documented repair and operative details rather than choosing by the general term repair alone.
On this page
CMS RVU26D · Effective 2026-10-01
43361 GI repair Medicare reimbursement rates in Vermont
Reports major operative repair in the esophageal gastrointestinal surgery family, with selection based on the specific repair performed and operative circumstances. Compare 43361 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 43361 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
$2304.52
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.
Gastrointestinal surgery
About 43361: Gastrointestinal tract surgical repair
Reports major operative repair in the esophageal gastrointestinal surgery family, with selection based on the specific repair performed and operative circumstances.
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.
CMS billing rules for 43361
- 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 RVU44.54 · 59%
- Practice expense (office) RVU18.60 · 25%
- Malpractice RVU11.94 · 16%
27
Medicare services in 2024 · #5738 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.
43361 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
This related code is associated with repair involving a fistula. Use the code that matches whether the documented service includes that condition.
No office rate
This neighboring code also has a gastrointestinal repair descriptor. Distinguish the codes using the specific procedure documented in the operative report.
Compare 43361 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
$2304.52
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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 43361 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,242
- Code
- 43361
- Physician work
- 44.54
- Practice expense
- 18.60
- Malpractice
- 11.94
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 44.54 | × 1.000 | 44.5400 |
| Practice expense | 18.60 | × 0.990 | 18.4140 |
| Malpractice | 11.94 | × 0.506 | 6.0416 |
| Total RVUs | 68.9956 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$2304.52
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 44.54 | 1 |
| Practice expense | 18.6 | 0.99 |
| Malpractice | 11.94 | 0.506 |
(44.54 × 1 + 18.6 × 0.99 + 11.94 × 0.506) × $33.4009 = $2304.52
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.
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 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.
5,23943351,,Surgical opening esophagus,A,,21.50,11.28,NA,11.28,,5.41,38.19,38.19,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24043352,,Surgical opening esophagus,A,,17.36,9.24,NA,9.24,,4.36,30.96,30.96,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24143360,,Gastrointestinal repair,A,,39.11,14.54,NA,14.54,,9.87,63.52,63.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24243361,,Gastrointestinal repair,A,,44.54,18.60,NA,18.60,,11.94,75.08,75.08,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24343400,,Ligate esophagus veins,A,,24.96,10.89,NA,10.89,,6.67,42.52,42.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,24443405,,Ligate/staple esophagus,A,,24.11,11.80,NA,11.80,,6.07,41.98,41.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2454340F,,Cnslng chldbrng women epi,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,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