CPT code 43305: Esophageal repair2026 Medicare rate & RVUs in Washington
Reports operative repair of the esophagus together with closure of an associated fistula, such as a tracheoesophageal connection, during the same procedure.
CMS doesn’t publish an office rate for 43305 in Washington.
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 43305 covers
A surgeon repairs the esophagus and closes an associated fistula, commonly a tracheoesophageal communication. This may be performed for a congenital abnormal connection or another surgically treated esophageal-fistula condition. The operative report should identify the esophageal defect, the fistula repaired, and the surgical approach. This is an operative service, generally performed in a hospital or other surgical facility.
Choose this code when the documented operation includes both esophageal repair and fistula closure; use the full code descriptor and operative details to distinguish it from related esophageal repair codes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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.
Where 43305 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $944.84 |
| Seattle (King Cnty) | Unavailable | $1,018.09 |
How the 43305 rate is calculated
Each of 43305’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 · 43305
RVUs × geographic indexes × conversion factor
Work17.65
17.65 RVUs× 1.000 GPCI
Practice expense8.02
8.02 RVUs× 1.000 GPCI
Malpractice2.58
2.58 RVUs× 1.000 GPCI
Adjusted RVUs
28.2500
Conversion factor
$33.4009
Medicare rate
$943.58
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43305
43305 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43305
Esophageal 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 · 43305
Esophageal 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
43305 without 51 · national facility
$943.58
Esophageal repair
43305-51 · Second procedure: 50%
$471.79
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%).
43305 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43312Esophageal repair
- Both codes involve esophageal repair with fistula closure. Use the complete descriptors and operative report to identify which code matches the documented procedure and approach.
- 43300Esophageal repair
- This is a nearby esophageal repair code. Check whether the operation includes fistula closure and compare the full descriptor before selecting between the codes.
- 43313Esophageal repair
- This code describes congenital esophagoplasty. Choose it when that congenital esophageal reconstruction procedure, rather than the repair represented by 43305, is documented.
43305 billing questions
How is this code distinguished from 43312?
Both descriptors concern esophageal repair with fistula repair. Check the complete code descriptors and operative report for the distinction, including the documented surgical approach.
Can the fistula closure be billed separately?
When fistula closure is part of the esophageal repair reported with this code, it is included in that service. The operative report should support both elements of the coded procedure.
Should modifier 50 be appended for a fistula involving paired structures?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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