No office rate
Both use a cervical approach, but 43305 includes repair of a tracheoesophageal fistula; 43300 does not.
On this page
CMS RVU26D · Effective 2026-10-01
43300 Esophageal repair Medicare reimbursement rates in Wisconsin
Open cervical repair of an esophageal defect without tracheoesophageal fistula repair, reported when the surgeon repairs the esophagus through a neck approach. Compare 43300 office and facility rates across CMS payment localities in Wisconsin.
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 43300 in Wisconsin?
Wisconsin 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
$512.72
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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.
Esophageal surgery
About 43300: Cervical esophageal repair without fistula repair
Open cervical repair of an esophageal defect without tracheoesophageal fistula repair, reported when the surgeon repairs the esophagus through a neck approach.
This service involves surgically repairing an esophageal defect through a cervical incision, without repairing a tracheoesophageal fistula. A surgeon may perform it for a cervical esophageal injury or perforation requiring operative closure. The work is generally performed in a hospital operating room by a surgeon experienced in esophageal or upper gastrointestinal surgery; the operative report should identify the cervical approach and the esophageal repair performed.
Report this code when the operative work matches the cervical approach and does not include repair of a tracheoesophageal fistula. Documentation should describe the defect, the repair, the approach, and whether a fistula was repaired. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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% multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43300
- 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 RVU9.10 · 55%
- Practice expense (office) RVU6.10 · 37%
- Malpractice RVU1.32 · 8%
25
Medicare services in 2024 · #5789 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.
43300 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
Both describe esophageal repair without fistula repair. Select 43300 for the cervical approach and 43310 for the thoracic approach.
No office rate
43312 is the thoracic-approach repair that includes fistula repair; 43300 is cervical and excludes fistula repair.
Compare 43300 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$512.72
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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 43300 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
5,217
- Code
- 43300
- Physician work
- 9.10
- Practice expense
- 6.10
- Malpractice
- 1.32
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.10 | × 1.000 | 9.1000 |
| Practice expense | 6.10 | × 0.958 | 5.8438 |
| Malpractice | 1.32 | × 0.308 | 0.4066 |
| Total RVUs | 15.3504 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$512.72
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.1 | 1 |
| Practice expense | 6.1 | 0.958 |
| Malpractice | 1.32 | 0.308 |
(9.1 × 1 + 6.1 × 0.958 + 1.32 × 0.308) × $33.4009 = $512.72
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.
43300 billing questions
When should 43300 be chosen over 43305?
Use 43300 for cervical esophageal repair without tracheoesophageal fistula repair. Use 43305 when the surgeon also repairs a fistula through the cervical approach.
How does 43300 differ from 43310?
The approach distinguishes these repairs: 43300 is performed through a cervical approach, while 43310 is the thoracic-approach repair without fistula repair.
What documentation supports reporting 43300?
The operative report should establish the cervical approach, the esophageal defect and its repair, and whether tracheoesophageal fistula repair was performed.
How does Medicare treat other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction. The 90-day global period includes the day-before preoperative visit and related postoperative care.
Can an assistant or co-surgeon be reported for 43300?
Medicare may pay an assistant at surgery. Co-surgeon payment requires supporting documentation, and 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.
5,2144328F,,Pt asked re sleep disturb,I,,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
5,21543290,,Egd flx trnsorl dplmnt balo,A,,3.03,76.51,,1.32,,0.36,79.90,4.71,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,21643291,,Egd flx trnsorl rmvl balo,A,,2.73,12.14,,1.23,,0.30,15.17,4.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,21743300,,Repair of esophagus,A,,9.10,6.10,NA,6.10,,1.32,16.52,16.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,21843305,,Repair esophagus and fistula,A,,17.65,8.02,NA,8.02,,2.58,28.25,28.25,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2194330F,,Cnslng epi spec sfty issues,I,,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
5,22043310,,Repair of esophagus,A,,25.60,9.89,NA,9.89,,6.44,41.93,41.93,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,