CPT 43400
Global 090 ActiveLigate esophagus veins
CPT 43400 Billing & Documentation Guide
CPT code 43400 (Ligate esophagus veins) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 24.96, a non-facility practice expense RVU of 10.89, and a malpractice RVU of 6.67, a total non-facility RVU of 42.52 and facility RVU of 42.52. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1421.02, though rates vary from $1250.76 to $1775.76 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43400, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 43400 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 43400 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 43400
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 24.96 | 24.96 |
| Practice Expense RVU | 10.89 | 10.89 |
| Malpractice RVU | 6.67 | 6.67 |
| Total RVU | 42.52 | 42.52 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43400
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1414.78 | $1414.78 | $1365.93 - $1569.31 | 29 |
| Florida | $1632.32 | $1632.32 | $1516.26 - $1775.76 | 3 |
| Georgia | $1448.51 | $1448.51 | $1423.7 - $1473.31 | 2 |
| Illinois | $1613.81 | $1613.81 | $1513.99 - $1716.37 | 4 |
| Michigan | $1488.8 | $1488.8 | $1417.3 - $1560.31 | 2 |
| North Carolina | $1315.41 | $1315.41 | $1315.41 - $1315.41 | 1 |
| New York | $1581.88 | $1581.88 | $1335.85 - $1733.23 | 5 |
| Ohio | $1390.34 | $1390.34 | $1390.34 - $1390.34 | 1 |
| Pennsylvania | $1435.63 | $1435.63 | $1378.13 - $1493.12 | 2 |
| Texas | $1403.31 | $1403.31 | $1371.65 - $1508.1 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 43400
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43400 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0008T | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 43400
What does CPT code 43400 mean? +
CPT code 43400 represents: Ligate esophagus veins. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 43400? +
The 2026 Medicare national average non-facility payment for CPT 43400 is $1421.02. Rates range from $1250.76 to $1775.76 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43400? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 43400? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on April 17, 2026.
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