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Billing code 43180: DiverticulotomyMedicare rate & RVUs

Rigid transoral esophagoscopy with endoscopic division of a hypopharyngeal or cervical esophageal diverticulum, typically to treat Zenker's diverticulum.

CMS RVU26DEffective Oct 1, 2026109 payment localities899 Medicare services in 2024

Medicare pays $478.97 for 43180 nationally in a facility.

Medicare rate · 43180

Diverticulotomy

Swap in your local Medicare rate.

Work RVUs
8.8
Total RVUs
14.34
Global days
090

National rate · 2026

$478.97

Facility setting, before claim adjustments.

See every locality for 43180 → · 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 43180 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 43180 covers

This service treats a hypopharyngeal or cervical esophageal diverticulum, most commonly a Zenker's diverticulum. The surgeon passes a rigid esophagoscope through the mouth and divides the tissue septum separating the pouch from the esophageal lumen. Otolaryngologists and thoracic surgeons typically perform the operation in a hospital operating room under anesthesia.

Report this code when the rigid transoral approach is used to perform the endoscopic diverticulotomy; documentation should identify the diverticulum, approach, and septum division. The procedure has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. If 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 inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are 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 43180 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

43180 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$442.32
Alaska*Unavailable$615.47
ArizonaUnavailable$468.29
ArkansasUnavailable$437.83
AtlantaUnavailable$490.91
AustinUnavailable$482.76
BakersfieldUnavailable$481.01
Baltimore/Surr. CntysUnavailable$504.36
BeaumontUnavailable$463.15
BrazoriaUnavailable$470.42

43180 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
43180 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 43180 rate is calculated

Each of 43180’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 · 43180

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 8.80Practice expense 4.23Malpractice 1.31

14.3400 adjusted RVUs×$33.4009 conversion factor=$478.97

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

Payment rules and modifiers for 43180

43180 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43180

Diverticulotomy

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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
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 · 43180

Diverticulotomy

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

43180 without 51 · national facility

$478.97

Diverticulotomy

43180-51 · Second procedure: 50%

$239.49

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

43180 compared with similar codes

Compare codes

43180 vs 43130 vs 43191 vs 43193: national Medicare rates

Swap in your local Medicare rate.

  • 43180
    Diverticulotomy · 8.8 wRVU
    —
  • 43130
    Pouch excision · 12.22 wRVU
    —
  • 43191
    Esophagoscopy · 2.43 wRVU
    —
  • 43193
    Esophagoscopy · 2.72 wRVU
    —

How to choose

43130Pouch excision
43130 describes open removal of an esophageal pouch. This code describes endoscopic division of the diverticular septum through a rigid transoral scope.
43191Esophagoscopy
43191 is a rigid transoral diagnostic examination. Report this code when the session includes endoscopic diverticulotomy, not merely diagnostic esophagoscopy.
43193Esophagoscopy
43193 describes rigid transoral esophagoscopy with biopsy. It is for tissue sampling, not endoscopic division of a diverticular septum.

Codes related to 43180

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

Codes related to 43180
CodeHow it relatesNational office range
Used instead
43130Pouch excisionOpen removal of an esophageal pouch rather than endoscopic septum division.No office rate
43191EsophagoscopyRigid transoral diagnostic esophagoscopy when examination is performed without diverticulotomy.No office rate
43193EsophagoscopyRigid transoral esophagoscopy with biopsy when tissue sampling, rather than diverticulotomy, is performed.No office rate

43180 billing questions

When is the rigid approach used instead of flexible diverticulotomy?

This code is for endoscopic diverticulotomy performed with a rigid esophagoscope passed through the mouth. Flexible transoral diverticulotomy is reported with 43181.

How does this differ from open pouch surgery?

This code describes endoscopic division of the diverticular septum through a rigid scope. Code 43130 is an open operation to remove an esophageal pouch.

What documentation supports reporting this code?

The operative report should identify the hypopharyngeal or cervical esophageal diverticulum, the rigid transoral approach, and the endoscopic division of the septum.

Can modifier 50 be used for a diverticulum on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code's descriptor and anatomy.

How does the multiple-procedure reduction affect another procedure performed in the same session?

The highest-valued procedure is paid in full; other procedures in that session are subject to the standard 50% reduction.

Can an assistant surgeon or co-surgeon be paid for this service?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are 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 43180PPRRVU2026_Oct_nonQPP.csv, line 5,131 (RVU26D)

Open CMS sourceHow we calculate rates

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