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Billing code 43116: EsophagectomyMedicare rate & RVUs

Reports open resection of the distal two-thirds of the esophagus through chest and abdominal incisions, with reconstruction connecting the remaining esophagus to the stomach.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $4,578.26 for 43116 nationally in a facility.

Medicare rate · 43116

Esophagectomy

Swap in your local Medicare rate.

Work RVUs
90.67
Total RVUs
137.07
Global days
090

National rate · 2026

$4,578.26

Facility setting, before claim adjustments.

See every locality for 43116 → · 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 43116 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 43116 covers

Code 43116 represents an open resection of the distal two-thirds of the esophagus through a chest incision and a separate abdominal incision; the proximal stomach may also be removed. The remaining esophagus is joined to the stomach. Thoracic or upper gastrointestinal surgeons typically perform this hospital operation for disease requiring more than local lesion removal, such as selected esophageal cancers. The operative report should establish the resection extent, incisions, any proximal gastrectomy, and the stomach reconstruction.

Select this code when the documented operation matches that extent, approach, and reconstruction; a different resection extent or conduit may point to another esophagectomy code. Report the operation as a whole rather than separately reporting integral resection and reconstruction steps. The 90-day global includes the day-before preoperative visit and related postoperative care through day 90. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%. Report the resection once; modifier 50 is inappropriate. Assistant-at-surgery payment may be available, 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 43116 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

43116 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$4,148.39
Alaska*Unavailable$5,800.42
ArizonaUnavailable$4,443.86
ArkansasUnavailable$4,096.85
AtlantaUnavailable$4,753.52
AustinUnavailable$4,542.76
BakersfieldUnavailable$4,412.41
Baltimore/Surr. CntysUnavailable$4,865.18
BeaumontUnavailable$4,453.30
BrazoriaUnavailable$4,427.29

43116 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
43116 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 43116 rate is calculated

Each of 43116’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 · 43116

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 90.67Practice expense 23.52Malpractice 22.88

137.0700 adjusted RVUs×$33.4009 conversion factor=$4,578.26

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

Payment rules and modifiers for 43116

43116 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43116

Esophagectomy

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 · 43116

Esophagectomy

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

43116 without 51 · national facility

$4,578.26

Esophagectomy

43116-51 · Second procedure: 50%

$2,289.13

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

43116 compared with similar codes

Compare codes

43116 vs 43117 vs 43107 vs 43112 vs 43100: national Medicare rates

Swap in your local Medicare rate.

  • 43116
    Esophagectomy · 90.67 wRVU
    —
  • 43117
    Partial esophagectomy · 56.06 wRVU
    —
  • 43107
    Esophagectomy · 50.75 wRVU
    —
  • 43112
    Esophagectomy · 60.45 wRVU
    —
  • 43100
    Esophageal excision · 9.42 wRVU
    —

How to choose

43117Partial esophagectomy
The key distinction is the reconstruction: 43116 uses the stomach, while 43117 uses colon or small intestine.
43107Esophagectomy
43107 describes total or near-total esophagectomy without thoracotomy. Choose 43116 for the specified distal partial resection with thoracic and separate abdominal access.
43112Esophagectomy
43112 is for total or near-total esophagectomy with thoracotomy; 43116 is for partial resection of the distal two-thirds.
43100Esophageal excision
43100 is for excising an esophageal lesion. Use 43116 when the documented operation removes the distal two-thirds and includes stomach reconstruction.

Codes related to 43116

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

Codes related to 43116
CodeHow it relatesNational office range
Same family
43117Partial esophagectomyPartial esophagectomy with colon or small-intestine reconstruction instead of stomach reconstruction.No office rate
Used instead
43107EsophagectomyFor total or near-total esophagectomy without thoracotomy, rather than this partial resection through chest and abdominal incisions.No office rate
43112EsophagectomyFor total or near-total esophagectomy with thoracotomy, rather than this distal partial resection.No office rate
43100Esophageal excisionFor excision of an esophageal lesion rather than the larger partial esophageal resection reported with 43116.No office rate

43116 billing questions

How does 43116 differ from 43117?

Both are partial esophagectomy codes for an operation involving chest and abdominal access. The reconstruction distinguishes them: 43116 uses the stomach, while 43117 uses a colon or small-intestine reconstruction.

Can the resection and stomach reconstruction be reported separately?

Report 43116 for the complete operation, including the esophageal resection and the described stomach reconstruction. Do not separately report those integral operative steps.

Can modifier 50 be used for this operation?

No. Report the esophageal resection once; modifier 50 is inappropriate for this operation.

What documentation supports reporting 43116?

The operative report should identify the distal two-thirds resection, thoracotomy and separate abdominal incision, whether proximal stomach was removed, and the connection of the remaining esophagus to the stomach.

How are assistant and co-surgeon claims handled?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.

What does the 90-day global include?

It includes the day-before preoperative visit and related postoperative care through the 90-day period.

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 43116PPRRVU2026_Oct_nonQPP.csv, line 5,122 (RVU26D)

Open CMS sourceHow we calculate rates

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