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Billing code 43020: Esophageal incisionMedicare rate & RVUs

Reports an open incision into the cervical esophagus when operative treatment requires direct access through the neck rather than endoscopic access.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $551.78 for 43020 nationally in a facility.

Medicare rate · 43020

Esophageal incision

Swap in your local Medicare rate.

Work RVUs
8.02
Total RVUs
16.52
Global days
090

National rate · 2026

$551.78

Facility setting, before claim adjustments.

See every locality for 43020 → · Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 43020 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43020 covers

This service involves surgically opening the esophagus through a cervical approach. It is performed by a surgeon when the operative plan requires direct access to the neck portion of the esophagus; it is distinct from an endoscopic procedure performed through the mouth. The operative report should identify the cervical approach and describe the esophageal incision and its purpose.

Report the code for the cervical esophageal incision, not for a cricopharyngeal muscle procedure or a thoracic approach. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this descriptor and anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery 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 43020 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

43020 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$494.21
Alaska*Unavailable$667.43
ArizonaUnavailable$534.90
ArkansasUnavailable$487.16
AtlantaUnavailable$570.35
AustinUnavailable$556.49
BakersfieldUnavailable$549.32
Baltimore/Surr. CntysUnavailable$588.52
BeaumontUnavailable$527.59
BrazoriaUnavailable$536.29

43020 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
43020 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43020 rate is calculated

Each of 43020’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 · 43020

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 8.02Practice expense 6.36Malpractice 2.14

16.5200 adjusted RVUs×$33.4009 conversion factor=$551.78

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 43020

43020 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43020

Esophageal incision

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 43020

Esophageal incision

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43020 without 51 · national facility

$551.78

Esophageal incision

43020-51 · Second procedure: 50%

$275.89

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%).

When to use modifier 51

43020 compared with similar codes

Compare codes

43020 vs 43045 vs 43030 vs 43215: national Medicare rates

Swap in your local Medicare rate.

  • 43020
    Esophageal incision · 8.02 wRVU
    —
  • 43045
    Esophagotomy · 21.33 wRVU
    —
  • 43030
    Cricopharyngeal myotomy · 7.79 wRVU
    —
  • 43215
    Object removal · 2.38 wRVU
    $436.55

How to choose

43045Esophagotomy
Use this code for a cervical esophageal incision. Code 43045 describes a thoracic approach with foreign-body removal.
43030Cricopharyngeal myotomy
Code 43030 is a cricopharyngeal myotomy directed at the muscle; this code describes an incision into the esophagus.
43215Object removal
Code 43215 reports transoral endoscopic foreign-body removal. This code is for an open incision through a cervical approach.

Codes related to 43020

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

Codes related to 43020
CodeHow it relatesNational office range
Used instead
43045EsophagotomyThoracic esophagotomy with foreign-body removal when the operative approach is through the chest.No office rate
43215Object removalEndoscopic esophageal foreign-body removal when treatment is performed transorally.$382.07–$592.22
43247EGD removalEndoscopic foreign-body removal through an upper gastrointestinal endoscopy approach.$376.01–$569.47

43020 billing questions

How does this differ from 43045?

This code describes an esophageal incision by a cervical approach. Code 43045 describes a thoracic approach with foreign-body removal.

Is this the same as a cricopharyngeal myotomy?

No. Code 43030 addresses the cricopharyngeal muscle; this service is an incision into the esophagus through the neck.

Can an endoscopic foreign-body removal be reported instead?

When the foreign body is removed endoscopically, consider the applicable endoscopic removal code, such as 43215 or 43247, rather than an open cervical incision.

What documentation supports reporting this code?

Document the cervical surgical approach, the esophageal incision, and the operative reason for direct access. The operative note should distinguish the esophageal incision from work limited to the cricopharyngeal muscle.

Can modifier 50 be used for a bilateral procedure?

No. Modifier 50 is not appropriate for this code's descriptor and anatomy.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

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

Show the CMS file lines behind this rate
RVUs for 43020PPRRVU2026_Oct_nonQPP.csv, line 5,111 (RVU26D)

Open CMS sourceHow we calculate rates

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