CPT 43497
Global 090 ActiveTransorl lwr esophgl myotomy
CPT 43497 Billing & Documentation Guide
CPT code 43497 (Transorl lwr esophgl myotomy) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 12.96, a non-facility practice expense RVU of 6.75, and a malpractice RVU of 1.8, a total non-facility RVU of 21.51 and facility RVU of 21.51. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $728.48, though rates vary from $657.51 to $922.55 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43497, 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 43497 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 43497 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 43497
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 12.96 | 12.96 |
| Practice Expense RVU | 6.75 | 6.75 |
| Malpractice RVU | 1.8 | 1.8 |
| Total RVU | 21.51 | 21.51 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43497
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 | $747.77 | $747.77 | $719.56 - $837.82 | 29 |
| Florida | $776.12 | $776.12 | $738.77 - $819.62 | 3 |
| Georgia | $720.55 | $720.55 | $705.65 - $735.44 | 2 |
| Illinois | $767.13 | $767.13 | $732.69 - $800.47 | 4 |
| Michigan | $729.2 | $729.2 | $706.59 - $751.81 | 2 |
| North Carolina | $681.64 | $681.64 | $681.64 - $681.64 | 1 |
| New York | $786.65 | $786.65 | $689.32 - $840.29 | 5 |
| Ohio | $699.32 | $699.32 | $699.32 - $699.32 | 1 |
| Pennsylvania | $721.88 | $721.88 | $696.66 - $747.09 | 2 |
| Texas | $713.06 | $713.06 | $693.89 - $742.94 | 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 43497
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43497 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00520 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00731 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00732 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00811 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00812 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00813 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical 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 |
| 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 |
Frequently Asked Questions, CPT 43497
What does CPT code 43497 mean? +
CPT code 43497 represents: Transorl lwr esophgl myotomy. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 43497? +
The 2026 Medicare national average non-facility payment for CPT 43497 is $728.48. Rates range from $657.51 to $922.55 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43497? +
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 43497? +
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 June 2, 2026.
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