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Billing code 43100: Esophageal excisionMedicare rate & RVUs

Reports open removal of a localized lesion from the cervical esophagus through a neck approach, rather than endoscopic treatment or esophageal resection.

CMS RVU26DEffective Oct 1, 2026109 payment localities46 Medicare services in 2024

Medicare pays $558.13 for 43100 nationally in a facility.

Medicare rate · 43100

Esophageal excision

Swap in your local Medicare rate.

Work RVUs
9.42
Total RVUs
16.71
Global days
090

National rate · 2026

$558.13

Facility setting, before claim adjustments.

See every locality for 43100 → · 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 43100 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 43100 covers

Code 43100 describes an open operation to remove a localized lesion from the cervical portion of the esophagus through a neck incision. A surgeon, commonly an otolaryngologist or thoracic surgeon, exposes the esophagus, excises the lesion, and addresses the esophageal opening. The service is typically performed in a hospital operating room; it is not a code for endoscopic biopsy or transoral lesion removal.

Select this code when the operative report supports local excision using a cervical approach. Document the lesion, its esophageal location, the surgical approach, and whether the surgeon removed a focal lesion or resected an esophageal segment. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require 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 43100 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

43100 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$513.66
Alaska*Unavailable$707.93
ArizonaUnavailable$545.45
ArkansasUnavailable$508.17
AtlantaUnavailable$571.37
AustinUnavailable$565.07
BakersfieldUnavailable$565.36
Baltimore/Surr. CntysUnavailable$588.39
BeaumontUnavailable$537.08
BrazoriaUnavailable$548.87

43100 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
43100 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 43100 rate is calculated

Each of 43100’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 · 43100

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 9.42Practice expense 5.93Malpractice 1.36

16.7100 adjusted RVUs×$33.4009 conversion factor=$558.13

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

Payment rules and modifiers for 43100

43100 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43100

Esophageal excision

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 · 43100

Esophageal excision

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

43100 without 51 · national facility

$558.13

Esophageal excision

43100-51 · Second procedure: 50%

$279.07

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

43100 compared with similar codes

Compare codes

43100 vs 43101 vs 43180 vs 43116: national Medicare rates

Swap in your local Medicare rate.

  • 43100
    Esophageal excision · 9.42 wRVU
    —
  • 43101
    Esophageal lesion excision · 16.64 wRVU
    —
  • 43180
    Diverticulotomy · 8.8 wRVU
    —
  • 43116
    Esophagectomy · 90.67 wRVU
    —

How to choose

43101Esophageal lesion excision
This is the neighboring open lesion-excision code for a different surgical approach. Choose between 43100 and 43101 from the approach documented in the operative report.
43180Diverticulotomy
43180 describes rigid transoral endoscopic lesion excision; 43100 describes open excision through a cervical approach.
43116Esophagectomy
43116 is for partial esophageal removal. Use 43100 for local lesion excision when the operation does not remove an esophageal segment.

Codes related to 43100

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

Codes related to 43100
CodeHow it relatesNational office range
Same family
43101Esophageal lesion excisionOpen esophageal lesion excision in the alternate approach category.No office rate
Used instead
43180DiverticulotomyRigid transoral endoscopic excision of an esophageal lesion.No office rate
43116EsophagectomyPartial esophageal removal when treatment requires resection rather than local lesion excision.No office rate

43100 billing questions

How is 43100 distinguished from 43101?

Both describe open excision of an esophageal lesion, but 43100 is for a cervical approach. Use 43101 when the documented approach is the one specified by that code.

Can 43100 be used for endoscopic lesion removal?

No. It represents open excision through a cervical approach. Rigid transoral endoscopic lesion excision is represented by 43180.

When is a partial esophagectomy code more appropriate?

Use a partial esophagectomy code when the surgeon removes an esophageal segment rather than locally excising a lesion. The operative report should make the extent of removal clear.

Can modifier 50 be appended?

No. The CMS bilateral adjustment does not apply to 43100, and modifier 50 is inappropriate for this service.

What postoperative care is included?

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

How are assistant and co-surgeon claims handled?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is submitted; team surgery 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

Show the CMS file lines behind this rate
RVUs for 43100PPRRVU2026_Oct_nonQPP.csv, line 5,116 (RVU26D)

Open CMS sourceHow we calculate rates

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