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Billing code 43121: Partial esophagectomyMedicare rate & RVUs

Reports partial esophageal resection through a thoracotomy and separate abdominal incision, with reconstruction connecting the remaining esophagus to the stomach.

CMS RVU26DEffective Oct 1, 2026109 payment localities15 Medicare services in 2024

Medicare pays $2,678.75 for 43121 nationally in a facility.

Medicare rate · 43121

Partial esophagectomy

Swap in your local Medicare rate.

Work RVUs
50.14
Total RVUs
80.20
Global days
090

National rate · 2026

$2,678.75

Facility setting, before claim adjustments.

See every locality for 43121 → · 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 43121 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 43121 covers

A thoracic or general surgeon removes part of the esophagus through a chest incision and a separate abdominal incision. The operation may also remove the proximal stomach, and the reconstruction joins the remaining esophagus to the stomach. Esophageal cancer is a typical reason for this operation. It is generally performed in a hospital operating room rather than an office setting.

Select this code when the operative report supports partial esophagectomy by the specified approaches and esophagogastrostomy. Documentation should identify the resected portion, thoracotomy and separate abdominal incision, any proximal gastrectomy, and the reconstruction performed. The code has a 90-day global period, including 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 50% multiple-procedure reduction. Assistant-at-surgery payment and co-surgeons are permitted; team-surgery billing 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 43121 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

43121 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,422.59
Alaska*Unavailable$3,364.03
ArizonaUnavailable$2,599.84
ArkansasUnavailable$2,391.72
AtlantaUnavailable$2,778.07
AustinUnavailable$2,667.60
BakersfieldUnavailable$2,601.03
Baltimore/Surr. CntysUnavailable$2,848.19
BeaumontUnavailable$2,596.42
BrazoriaUnavailable$2,593.89

43121 rates by state

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

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Explore a state

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
43121 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 43121 rate is calculated

Each of 43121’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 · 43121

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 50.14Practice expense 17.40Malpractice 12.66

80.2000 adjusted RVUs×$33.4009 conversion factor=$2,678.75

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

Payment rules and modifiers for 43121

43121 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43121

Partial 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)2Permitted.
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 · 43121

Partial 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

43121 without 51 · national facility

$2,678.75

Partial esophagectomy

43121-51 · Second procedure: 50%

$1,339.38

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

43121 compared with similar codes

Compare codes

43121 vs 43100 vs 43107 vs 43122: national Medicare rates

Swap in your local Medicare rate.

  • 43121
    Partial esophagectomy · 50.14 wRVU
    —
  • 43100
    Esophageal excision · 9.42 wRVU
    —
  • 43107
    Esophagectomy · 50.75 wRVU
    —
  • 43122
    Esophagectomy · 43.08 wRVU
    —

How to choose

43100Esophageal excision
43100 describes excision of an esophageal lesion with primary repair. Choose 43121 when the surgeon performs partial esophagectomy through a thoracotomy and separate abdominal incision with esophagogastrostomy.
43107Esophagectomy
43107 represents total or near-total esophagectomy without thoracotomy. 43121 is for partial resection using a thoracotomy and separate abdominal incision, with the esophagus joined to the stomach.
43122Esophagectomy
Both are partial-esophagectomy family codes, but the reconstruction differs. Review the operative report for the conduit used rather than choosing by resection extent alone.

Codes related to 43121

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

Codes related to 43121
CodeHow it relatesNational office range
Same family
43117Partial esophagectomyNearby partial-esophagectomy variant; compare the documented operative approach and reconstruction.No office rate
43118Partial esophagectomyRelated partial-esophagectomy code; select by the operative details distinguishing the procedures.No office rate
43122EsophagectomyPartial-esophagectomy family code with a different reconstruction; verify the conduit documented.No office rate
43123EsophagectomyRelated partial-esophagectomy variant; compare its reconstruction with the stomach connection in 43121.No office rate
Used instead
43100Esophageal excisionFor esophageal lesion excision with primary repair rather than partial esophagectomy.No office rate
43107EsophagectomyFor total or near-total esophagectomy rather than partial removal.No office rate

43121 billing questions

What distinguishes this code from nearby partial-esophagectomy codes?

Confirm the operative approach and reconstruction, not just the amount of esophagus removed. This code describes thoracotomy, a separate abdominal incision, and connection of the esophagus to the stomach.

Can a focal esophageal lesion excision be reported instead?

A lesion-excision code such as 43100 is for excising a lesion with primary repair. Use 43121 when the operation is a partial esophagectomy with the approaches and reconstruction documented for this code.

What documentation supports reporting 43121?

The operative report should establish the partial resection, thoracotomy, separate abdominal incision, and esophagogastrostomy. It should also state whether proximal stomach was removed.

How does the multiple-procedure reduction work?

For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction.

Can an assistant or co-surgeon be reported?

CMS permits assistant-at-surgery payment and co-surgeons for this code. Team-surgery billing 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 43121PPRRVU2026_Oct_nonQPP.csv, line 5,125 (RVU26D)

Open CMS sourceHow we calculate rates

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