Summary & Overview

CPT 43280: Laparoscopic Esophagogastric Fundoplasty, Antireflux Surgery

CPT code 43280 represents laparoscopic esophagogastric fundoplasty, a minimally invasive antireflux surgical procedure that reinforces the lower esophageal sphincter by wrapping the gastric fundus around the distal esophagus. The procedure matters nationally because GERD is a common condition and fundoplasty is a definitive surgical option for patients who fail or cannot tolerate medical therapy, impacting hospital and ambulatory surgical volumes and surgical specialty practice patterns. Key payers in the overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing context for the procedure, typical sites of service, common modifiers used in billing, and the payer mix considered in benchmarking. The publication outlines what to expect in terms of coding identification, clinical indications, and the types of comparisons and policy updates typically relevant to this code. Data not available in the input is noted where applicable; the focus remains on delivering a clear, national-level summary of the code’s clinical role and payer coverage landscape rather than state-specific policy details.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 43280antireflux surgerylaparoscopic fundoplicationGERD surgerysurgical codingambulatory surgeryhospital outpatient surgeryprocedure codingminimally invasive surgery

Billing Code Overview

CPT code 43280 describes a laparoscopic esophagogastric fundoplasty, a surgical procedure in which the upper part of the stomach is wrapped around the lower esophagus to reinforce the lower esophageal sphincter. This procedure is used to treat gastroesophageal reflux disease (GERD) when medical management is insufficient.

Service Type: Surgical — Minimally Invasive (Laparoscopic) Antireflux Surgery

Typical Site of Service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient with long-standing symptomatic gastroesophageal reflux disease (GERD) refractory to optimized medical therapy presents for surgical management. The surgeon performs a 43280 laparoscopic esophagogastric fundoplasty (Nissen or partial fundoplication) to reinforce the lower esophageal sphincter by wrapping the gastric fundus around the distal esophagus. Preoperative evaluation includes upper endoscopy, esophageal manometry, and 24-hour pH monitoring to confirm reflux etiology and rule out motility disorders. The procedure is performed in an ambulatory surgery center or hospital operating room under general anesthesia with laparoscopic access. Intraoperative steps include hiatal dissection, crural repair if a hiatal hernia is present, mobilization of the gastric fundus, creation of the fundoplication wrap, and confirmation of wrap tension and position. Postoperative workflow includes recovery room monitoring, early ambulation, diet advancement from clear liquids to soft diet, discharge instructions for activity restrictions, and outpatient follow-up with the surgeon for wound and symptom assessment. Typical indications include chronic reflux symptoms, regurgitation, or complications of GERD such as erosive esophagitis or Barrett esophagus where surgical intervention is appropriate.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work, time, or technical difficulty of `43280` is substantially greater than usual and well documented.
`23`	Unusual anesthesia	Use when general anesthesia for `43280` is medically contraindicated and unusual anesthesia circumstances are required.
`26`	Professional component	Use if billing separately for the surgeon's professional component in environments where technical and professional components are split.
`52`	Reduced services	Use when `43280` is partially performed or the full procedure is not completed but some components were carried out.
`53`	Discontinued procedure	Use when `43280` is started but terminated due to extenuating circumstances or patient condition.
`62`	Two surgeons	Use when two surgeons with distinct roles are documented as necessary for `43280`.
`66`	Surgical team (multiple surgeons)	Use when a documented surgical team performs `43280` and team reporting is appropriate.
`73`	Discontinued outpatient prior to anesthesia	Use if `43280` on an outpatient basis is cancelled after the patient is prepared but before anesthesia is administered.
`74`	Discontinued outpatient after anesthesia start	Use if `43280` begins under anesthesia but is terminated before completion while the patient is still in the operating room.
`78`	Unplanned return to OR following initial procedure	Use when `43280` requires a related unplanned return to the operating room for a complication.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use for an unrelated procedure performed during the global period after `43280`.
`59`	Distinct procedural service	Use when a separately identifiable procedure distinct from `43280` is performed during the same encounter; document distinct procedural elements.
`AS`	Physician assistant, nurse practitioner, clinical nurse specialist services for surgical procedures	Use when an advanced practice clinician provides designated services for `43280` as permitted by payer rules.
`51`	Multiple procedures	Use when `43280` is billed with other procedures performed in the same session; apply appropriate multiple-procedure reduction rules.

Taxonomy Code	Specialty	Notes
`208000000X`	General Surgery	Most common specialty performing `43280`; manages laparoscopic fundoplication and hiatal hernia repair.
`208600000X`	Gastrointestinal Surgery	Subspecialty focused on foregut procedures including `43280`.
`207L00000X`	Colon & Rectal Surgery	May perform foregut surgery in some practices; less common for fundoplication.
`363L00000X`	Thoracic Surgery	Performs fundoplication in cases needing thoracic approach or combined thoracoabdominal management.
`208100000X`	Surgery - Plastic/Reconstructive (not typical)	Data not applicable for primary performance of this procedure; included only if reconstructive issues arise.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K21.0`	Gastro-esophageal reflux disease with esophagitis	Common primary indication for `43280` when medical therapy fails or mucosal injury is present.
`K21.9`	Gastro-esophageal reflux disease without esophagitis	Indication for surgical intervention when symptoms are chronic and refractory to medical management.
`K44.9`	Diaphragmatic hernia without obstruction or gangrene (includes hiatal hernia)	Hiatal hernia often coexists with GERD and may be repaired during `43280`.
`K22.7`	Other and unspecified diseases of the esophagus (includes Barrett's esophagus)	Barrett esophagus or other esophageal pathology can influence surgical decision-making for fundoplication.
`K31.89`	Other diseases of stomach and duodenum	Includes conditions that may be assessed or addressed in foregut surgery planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43280`	Laparoscopic esophagogastric fundoplasty (e.g., Nissen)	Primary procedural code for laparoscopic fundoplication to treat GERD.
`43281`	Laparoscopic revision of fundoplication	Used when revision or takedown of a prior `43280` is required due to failure or complications.
`43289`	Laparoscopy, surgical; other procedure (specify)	Sometimes used for additional laparoscopic foregut procedures performed concurrently with `43280` when no specific code applies.
`43200`	Esophagoscopy, flexible, diagnostic, with or without collection of specimen by brushing or washing; with/without biopsy	Performed preoperatively or intraoperatively for diagnostic evaluation of esophageal mucosa related to indications for `43280`.
`43644`	Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)	Different bariatric procedure — listed here when concurrent bariatric operations or conversions are part of the surgical plan; not typically performed with `43280` but relevant in foregut surgical workflows.
`43255`	Laparoscopy, surgical; esophagogastric fundoplasty (e.g., Nissen) — alternative coding	Historically used as an alternate approach; verify payer guidance for preferred coding when performing fundoplication.