CPT code 43420: Esophageal repair, cervical approach2026 Medicare rate & RVUs in Illinois
Reports operative repair of an esophageal opening through a cervical approach, including repair associated with an esophageal diverticulum.
CMS doesn’t publish an office rate for 43420 in Illinois.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | $987.24 |
| East St. Louis, IL | Unavailable | $939.52 |
| Rest of Illinois | Unavailable | $901.75 |
| Suburban Chicago, IL | Unavailable | $951.05 |
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.
How the rate is built · 43420
RVUs × geographic indexes × conversion factor
Work16.36
16.36 RVUs× 1.000 GPCI
Practice expense7.56
7.56 RVUs× 1.000 GPCI
Malpractice2.39
2.39 RVUs× 1.000 GPCI
Adjusted RVUs
26.3100
Conversion factor
$33.4009
Medicare rate
$878.78
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43420
43420 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43420
Esophageal repair, cervical approach
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43420
Esophageal repair, cervical approach
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43420 without 51 · national facility
$878.78
Esophageal repair, cervical approach
43420-51 · Second procedure: 50%
$439.39
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43420 compared with similar codes
Compare codes · National
4 codes, side by side
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.
43420 billing questions
How does 43420 differ from 43425?
The approach determines the choice: 43420 is for a cervical repair, while 43425 is for a thoracic repair. The operative report should support the route used.
When should an esophageal wound repair code be considered instead?
Use the wound-repair code family when repairing an esophageal wound or injury. 43420 describes repair of an esophageal opening through a cervical approach.
What documentation supports reporting 43420?
Document the esophageal defect or opening, the cervical approach, and the repair performed. The operative report should make clear whether the service was repair of an opening rather than repair of a wound or injury.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this esophageal repair.
How is 43420 handled when other procedures occur in the same session?
CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the other procedures. The 90-day global period includes the day-before preoperative visit and related postoperative care.
What documentation is needed for assistant or co-surgeon payment?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
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
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