Billing code 43334: Diaphragmatic hernia repairMedicare rate & RVUs in Washington
Reports transthoracic repair of a non-neonatal diaphragmatic hernia when the operation uses no mesh or other prosthesis.
CMS doesn’t publish an office rate for 43334 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 43334 covers
This code describes operative repair of a diaphragmatic hernia through a transthoracic approach, without mesh or another prosthesis. Thoracic or general surgeons may perform it in a hospital operating room for a diaphragmatic defect requiring repair through the chest. The operative report should identify the hernia and document the transthoracic route and whether prosthetic material was implanted; a repair using mesh belongs to the corresponding mesh code, 43335.
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and applies a 50% reduction to the others. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; 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 43334 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,146.56 |
| Seattle (King Cnty) | Unavailable | $1,229.38 |
How the 43334 rate is calculated
Each of 43334’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 · 43334
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.57Practice expense 7.91Malpractice 5.45
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43334
43334 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43334
Diaphragmatic hernia 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 · 43334
Diaphragmatic hernia 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
43334 without 51 · national facility
$1,166.69
Diaphragmatic hernia repair
43334-51 · Second procedure: 50%
$583.35
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%).
43334 compared with similar codes
Compare codes
43334 vs 43335 vs 43336 vs 43332: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43335Hiatal hernia repair
- Both describe transthoracic diaphragmatic hernia repair; 43335 is the corresponding choice when mesh or another prosthesis is implanted.
- 43336Hernia repair
- 43334 uses a transthoracic approach. Choose 43336 when the documented repair uses a thoracoabdominal approach and no prosthesis is implanted.
- 43332Hiatal hernia repair
- 43332 is for transabdominal repair of a paraesophageal hiatal hernia. 43334 is for a diaphragmatic hernia repaired through the chest.
43334 billing questions
How is 43334 distinguished from 43335?
Use 43334 when the transthoracic repair is performed without mesh or another prosthesis. Use 43335 when prosthetic material is implanted.
When should 43336 be considered instead?
43336 describes repair through a thoracoabdominal approach without prosthetic material. The operative report should support the approach actually used.
Is modifier 50 appropriate for this repair?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Medicare pays the highest-valued procedure in full and reduces the other procedure or procedures by 50% under the standard multiple procedure rule.
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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