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CPT 43327: Partial or Complete Fundoplasty (Open Abdominal Fundoplication)

CPT code 43327 represents an open partial or complete fundoplasty (fundoplication) performed through an abdominal incision to reinforce the lower esophageal sphincter and address gastroesophageal reflux. This surgical code is clinically significant nationwide because fundoplication remains a common definitive treatment for refractory gastroesophageal reflux disease (GERD) and selected anatomical defects. The procedure’s resource use, hospital stay potential, and perioperative risk profile make accurate coding essential for clinical documentation, surgical quality measurement, and payment adjudication.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the procedure and its typical sites of service, context for clinical indications, and an outline of what to expect in payer coverage and billing practices. The publication highlights benchmarks for utilization and payment (when available), common billing considerations, and recent policy or coding clarifications that affect surgical anti-reflux procedures. The report is written for hospital billing managers, surgical practices, compliance officers, and policy analysts seeking a national perspective on coding and coverage for open fundoplication.

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Billing Code Overview

CPT code 43327 describes a partial or complete fundoplasty (fundoplication) performed through an abdominal incision, in which the upper portion of the stomach is wrapped around the lower esophagus. The procedure is a surgical intervention to reinforce the lower esophageal sphincter and reduce gastroesophageal reflux.

Service type: Open surgical anti-reflux procedure (fundoplication)
Typical site of service: Inpatient or outpatient hospital operating room, or ambulatory surgical center depending on clinical indication and facility capabilities.

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CPT 43327: Partial or Complete Fundoplasty (Open Abdominal Fundoplication)

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Get alerted when payer policies referencing 43327 are released or updated.

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Billing Code Overview

Service type: Open surgical anti-reflux procedure (fundoplication)
Typical site of service: Inpatient or outpatient hospital operating room, or ambulatory surgical center depending on clinical indication and facility capabilities.

Clinical & Coding Specifications

Clinical Context

A 54-year-old patient with chronic gastroesophageal reflux disease (GERD) complicated by a large, symptomatic hiatal hernia and failed maximal medical therapy presents for surgical management. The patient reports persistent heartburn, regurgitation, and nocturnal symptoms despite proton pump inhibitor therapy and lifestyle modification. Preoperative workup includes upper endoscopy showing esophagitis and a sliding hiatal hernia, barium swallow documenting reflux and herniation, and esophageal manometry to assess motility. The surgical team elects to perform a partial or complete fundoplication via an open abdominal approach when anatomy, prior abdominal surgery, or intraoperative findings preclude a laparoscopic approach.

The clinical workflow includes preoperative clearance, informed consent noting risks and benefits of 43327 (open fundoplasty), anesthesia evaluation, intraoperative placement of an abdominal incision with mobilization of the gastric fundus and creation of a partial (e.g., Toupet) or complete (Nissen) wrap around the distal esophagus, and possible concurrent hiatal hernia repair. Postoperative care involves pain control, monitoring for dysphagia, early ambulation, diet advancement from clear liquids, and outpatient follow-up with symptom assessment and potential swallow study if dysphagia or leak is suspected.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to perform `43327` is substantially greater than typical due to complexity, e.g., dense adhesions or extensive repair.
`23`	Unusual anesthesia	Use if `43327` is performed with general anesthesia contraindicated and unusually deep sedation or monitored anesthesia care is required.
`26`	Professional component	Use if billing only for the physician professional component when split billing applies (rare for this global surgical code).
`50`	Bilateral procedure	Not typically applicable to `43327`; included only if documentation supports bilateral operative work (rare).
`51`	Multiple procedures	Use when `43327` is billed with other distinct procedures on the same date; append when payer requires identification of multiple procedures.
`52`	Reduced services	Use when `43327` is partially performed or aborted but some work was completed.
`53`	Discontinued procedure	Use when `43327` is started but halted for patient safety before completion.
`62`	Two surgeons	Use when two surgeons are required and both perform distinct portions of `43327` concurrently due to complexity.
`63`	Procedure performed on infants less than 4 kg	Use when applicable to neonatal patients meeting weight criteria.
`66`	Surgical team approach	Use when a documented surgical team approach is used for `43327` per payer requirements.
`78`	Return to OR for related procedure during global period	Use when patient returns to the operating room for a related procedure for a complication of `43327` during the global period.
`79`	Unrelated procedure or service by same physician during global period	Use when an unrelated procedure is performed by the same surgeon during the global period (not listed in raw modifiers but standard; not included here because not in provided list).

Taxonomy Code	Specialty	Notes
207P00000X	General Surgery	Most commonly performs open fundoplasty surgeries such as `43327`.
208800000X	Colon & Rectal Surgery	May perform when colorectal pathology or complex abdominal adhesions are present.
2080S0122X	Thoracic Surgery	Performs antireflux procedures when thoracic approach or complex esophageal disease requires thoracic expertise.
207X00000X	Pediatric Surgery	Performs fundoplasty in pediatric patients when indicated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K21.9`	Gastroesophageal reflux disease without esophagitis	Common indication for fundoplication when medical therapy fails.
`K21.0`	Gastro-esophageal reflux disease with esophagitis	Indicates mucosal injury from reflux, often prompting surgical intervention like `43327`.
`K44.9`	Diaphragmatic hernia without obstruction or gangrene	Includes hiatal hernia presentations that may require fundoplication with hernia repair.
`K44.1`	Diaphragmatic hernia with obstruction	Relevant when hiatal hernia causes obstructive symptoms necessitating surgical repair concurrent with fundoplasty.
`R12`	Heartburn	Symptom code that documents primary reflux symptom leading to consideration of `43327`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43280`	Upper gastrointestinal endoscopy, flexible, transoral; with directed submucosal injection(s), any substance	Preoperative diagnostic endoscopy may be performed to evaluate esophagitis or other mucosal disease prior to `43327`.
`43235`	Esophagogastroduodenoscopy, flexible, transoral; diagnostic, with or without collection of specimen(s) by brushing or washing	Commonly performed preoperatively to assess esophageal and gastric mucosa before fundoplasty.
`39530`	Repair of paraesophageal hiatal hernia, with or without gastropexy; thoracic approach	Alternative or adjunct procedure when hiatal hernia requires thoracic repair instead of abdominal approach.
`43644`	Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (e.g., for obesity)	Not routinely performed with `43327` but listed as related upper GI surgical procedures; included for perioperative coding context.
`43775`	Laparoscopic surgical procedure, repair of paraesophageal hiatal hernia, with or without fundoplication	Minimally invasive alternative to open `43327`; may be performed instead of or prior to conversion to open approach.

CPT 43300: Esophageal Reconstruction via Cervical Incision

CPT-43305-ESOPHAGEAL-REPAIR-CERVICAL-APPROACH-TRACHEOESOPHAGEAL-FISTULA-REPAIR

CPT 43305: Esophageal Repair via Cervical Approach, Tracheoesophageal Fistula Repair

CPT-43310-ESOPHAGEAL-RECONSTRUCTION-THORACOTOMY

CPT 43310: Esophageal Repair/Reconstruction via Thoracotomy

CPT-43312-ESOPHAGEAL-RECONSTRUCTION-TRACHEOESOPHAGEAL-FISTULA-REPAIR

CPT 43312: Esophageal Reconstruction with Tracheoesophageal Fistula Repair

CPT-43313-CONGENITAL-ESOPHAGEAL-RECONSTRUCTION-THORACOTOMY

CPT 43313: Congenital Esophageal Reconstruction via Thoracotomy

CPT-43314-CONGENITAL-ESOPHAGEAL-REPAIR-THORACOTOMY

CPT 43314: Repair of Congenital Esophageal Defect via Thoracotomy

CPT-43320-LOWER-ESOPHAGUS-UPPER-STOMACH-REPAIR-OPEN-SURGERY

CPT 43320: Plastic Repair of Lower Esophagus and Upper Stomach

CPT-43325-DISTAL-ESOPHAGUS-REPAIR-WITH-FUNDIC-PATCH

CPT 43325: Repair of Distal Esophagus With Fundic Patch

CPT-43328-THORACIC-FUNDOPLASTY-FUNDOPLICATION-CHEST-APPROACH

CPT 43328: Thoracic Fundoplasty (Open Fundoplication)

CPT-43330-ESOPHAGEAL-REPAIR-ABDOMINAL-APPROACH

CPT 43330: Open Esophageal Repair via Abdominal Approach

Showing 1–10 of 30

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to perform `43327` is substantially greater than typical due to complexity, e.g., dense adhesions or extensive repair.
`23`	Unusual anesthesia	Use if `43327` is performed with general anesthesia contraindicated and unusually deep sedation or monitored anesthesia care is required.
`26`	Professional component	Use if billing only for the physician professional component when split billing applies (rare for this global surgical code).
`50`	Bilateral procedure	Not typically applicable to `43327`; included only if documentation supports bilateral operative work (rare).
`51`	Multiple procedures	Use when `43327` is billed with other distinct procedures on the same date; append when payer requires identification of multiple procedures.
`52`	Reduced services	Use when `43327` is partially performed or aborted but some work was completed.
`53`	Discontinued procedure	Use when `43327` is started but halted for patient safety before completion.
`62`	Two surgeons	Use when two surgeons are required and both perform distinct portions of `43327` concurrently due to complexity.
`63`	Procedure performed on infants less than 4 kg	Use when applicable to neonatal patients meeting weight criteria.
`66`	Surgical team approach	Use when a documented surgical team approach is used for `43327` per payer requirements.
`78`	Return to OR for related procedure during global period	Use when patient returns to the operating room for a related procedure for a complication of `43327` during the global period.
`79`	Unrelated procedure or service by same physician during global period	Use when an unrelated procedure is performed by the same surgeon during the global period (not listed in raw modifiers but standard; not included here because not in provided list).

Taxonomy Code	Specialty	Notes
207P00000X	General Surgery	Most commonly performs open fundoplasty surgeries such as `43327`.
208800000X	Colon & Rectal Surgery	May perform when colorectal pathology or complex abdominal adhesions are present.
2080S0122X	Thoracic Surgery	Performs antireflux procedures when thoracic approach or complex esophageal disease requires thoracic expertise.
207X00000X	Pediatric Surgery	Performs fundoplasty in pediatric patients when indicated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K21.9`	Gastroesophageal reflux disease without esophagitis	Common indication for fundoplication when medical therapy fails.
`K21.0`	Gastro-esophageal reflux disease with esophagitis	Indicates mucosal injury from reflux, often prompting surgical intervention like `43327`.
`K44.9`	Diaphragmatic hernia without obstruction or gangrene	Includes hiatal hernia presentations that may require fundoplication with hernia repair.
`K44.1`	Diaphragmatic hernia with obstruction	Relevant when hiatal hernia causes obstructive symptoms necessitating surgical repair concurrent with fundoplasty.
`R12`	Heartburn	Symptom code that documents primary reflux symptom leading to consideration of `43327`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43280`	Upper gastrointestinal endoscopy, flexible, transoral; with directed submucosal injection(s), any substance	Preoperative diagnostic endoscopy may be performed to evaluate esophagitis or other mucosal disease prior to `43327`.
`43235`	Esophagogastroduodenoscopy, flexible, transoral; diagnostic, with or without collection of specimen(s) by brushing or washing	Commonly performed preoperatively to assess esophageal and gastric mucosa before fundoplasty.
`39530`	Repair of paraesophageal hiatal hernia, with or without gastropexy; thoracic approach	Alternative or adjunct procedure when hiatal hernia requires thoracic repair instead of abdominal approach.
`43644`	Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (e.g., for obesity)	Not routinely performed with `43327` but listed as related upper GI surgical procedures; included for perioperative coding context.
`43775`	Laparoscopic surgical procedure, repair of paraesophageal hiatal hernia, with or without fundoplication	Minimally invasive alternative to open `43327`; may be performed instead of or prior to conversion to open approach.

CPT 43300: Esophageal Reconstruction via Cervical Incision

CPT-43305-ESOPHAGEAL-REPAIR-CERVICAL-APPROACH-TRACHEOESOPHAGEAL-FISTULA-REPAIR

CPT 43305: Esophageal Repair via Cervical Approach, Tracheoesophageal Fistula Repair

CPT-43310-ESOPHAGEAL-RECONSTRUCTION-THORACOTOMY

CPT 43310: Esophageal Repair/Reconstruction via Thoracotomy

CPT-43312-ESOPHAGEAL-RECONSTRUCTION-TRACHEOESOPHAGEAL-FISTULA-REPAIR

CPT 43312: Esophageal Reconstruction with Tracheoesophageal Fistula Repair

CPT-43313-CONGENITAL-ESOPHAGEAL-RECONSTRUCTION-THORACOTOMY

CPT 43313: Congenital Esophageal Reconstruction via Thoracotomy

CPT-43314-CONGENITAL-ESOPHAGEAL-REPAIR-THORACOTOMY

CPT 43314: Repair of Congenital Esophageal Defect via Thoracotomy

CPT-43320-LOWER-ESOPHAGUS-UPPER-STOMACH-REPAIR-OPEN-SURGERY

CPT 43320: Plastic Repair of Lower Esophagus and Upper Stomach

CPT-43325-DISTAL-ESOPHAGUS-REPAIR-WITH-FUNDIC-PATCH

CPT 43325: Repair of Distal Esophagus With Fundic Patch

CPT-43328-THORACIC-FUNDOPLASTY-FUNDOPLICATION-CHEST-APPROACH

CPT 43328: Thoracic Fundoplasty (Open Fundoplication)

CPT-43330-ESOPHAGEAL-REPAIR-ABDOMINAL-APPROACH

CPT 43330: Open Esophageal Repair via Abdominal Approach

Showing 1–10 of 30

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 43327: Partial or Complete Fundoplasty (Open Abdominal Fundoplication)

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Billing Code Overview

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CPT 43327: Partial or Complete Fundoplasty (Open Abdominal Fundoplication)

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 43327: Partial or Complete Fundoplasty (Open Abdominal Fundoplication)

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Billing Code Overview

CPT 43327: Partial or Complete Fundoplasty (Open Abdominal Fundoplication)

Sign up for cpt 43327 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 43327 represent and where is it typically performed?

What clinical indications and preoperative evaluations are associated with 43327?

Which modifiers are commonly referenced for billing CPT 43327 and when are they used?

What related CPT codes should be considered in the perioperative coding context for open fundoplication?

Which specialties and payers are associated with CPT 43327 in this summary?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 43327 represent and where is it typically performed?

What clinical indications and preoperative evaluations are associated with 43327?

Which modifiers are commonly referenced for billing CPT 43327 and when are they used?

What related CPT codes should be considered in the perioperative coding context for open fundoplication?

Which specialties and payers are associated with CPT 43327 in this summary?

References