CPT 43405
Global 090 ActiveLigate/staple esophagus
CPT 43405 Billing & Documentation Guide
CPT code 43405 (Ligate/staple esophagus) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 24.11, a non-facility practice expense RVU of 11.8, and a malpractice RVU of 6.07, a total non-facility RVU of 41.98 and facility RVU of 41.98. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1406.62, though rates vary from $1245.32 to $1739.4 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43405, 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 43405 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 43405 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 43405
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 24.11 | 24.11 |
| Practice Expense RVU | 11.8 | 11.8 |
| Malpractice RVU | 6.07 | 6.07 |
| Total RVU | 41.98 | 41.98 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43405
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 | $1410.47 | $1410.47 | $1359.62 - $1570.89 | 29 |
| Florida | $1595.41 | $1595.41 | $1486.81 - $1728.32 | 3 |
| Georgia | $1425.09 | $1425.09 | $1398.53 - $1451.64 | 2 |
| Illinois | $1576.39 | $1576.39 | $1482.02 - $1672.33 | 4 |
| Michigan | $1460.75 | $1460.75 | $1394.03 - $1527.46 | 2 |
| North Carolina | $1302.57 | $1302.57 | $1302.57 - $1302.57 | 1 |
| New York | $1558.81 | $1558.81 | $1322.25 - $1701.95 | 5 |
| Ohio | $1369.5 | $1369.5 | $1369.5 - $1369.5 | 1 |
| Pennsylvania | $1415.33 | $1415.33 | $1358.7 - $1471.95 | 2 |
| Texas | $1386.07 | $1386.07 | $1352.3 - $1482.08 | 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 43405
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43405 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 43405
What does CPT code 43405 mean? +
CPT code 43405 represents: Ligate/staple esophagus. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 43405? +
The 2026 Medicare national average non-facility payment for CPT 43405 is $1406.62. Rates range from $1245.32 to $1739.4 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43405? +
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 43405? +
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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