CPT code 43420: Esophageal repair, cervical approach2026 Medicare rate & RVUs

Medicare pays $878.78 for 43420 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 43420 covers

43420 describes operative repair of an esophageal opening reached through the neck. A typical situation is reconstruction after addressing an esophageal diverticulum. The surgeon closes or reconstructs the esophageal defect; this is an operative service, generally performed in a hospital operating room by a surgeon such as a thoracic or head-and-neck surgeon. The cervical route distinguishes this code from the thoracic approach in the same code family.

Select the code based on the operative approach and the nature of the defect. The operative report should identify the opening being repaired, the cervical approach, and the work performed; repair of an esophageal wound or injury is represented by different codes. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires medical-necessity documentation, co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 43420 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43420 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 43420 rate is calculated

Each of 43420’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 43420

43420 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

43420 compared with similar codes

How to choose

43425Fistula repairEsophageal opening

Both codes address repair of an esophageal opening; choose 43420 for the cervical approach and 43425 for the thoracic approach.

43410Esophageal repairCervical approach

43410 describes repair of an esophageal wound or injury through a cervical approach. 43420 is for repair of an esophageal opening, such as one associated with a diverticulum.

43415Esophageal repairThoracic or abdominal approach

43415 describes repair of an esophageal wound or injury through a thoracic approach. For repair of an opening, distinguish the cervical route of 43420 from the thoracic route of 43425.

Codes related to 43420

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates