Choose 43130 when the operation excises a hypopharyngeal or cervical esophageal diverticulum; its descriptor includes myotomy when performed. Use 43030 for myotomy without diverticulum excision.
On this page
CMS RVU26D · Effective 2026-10-01
43030 in Austin
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$472.09
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
ENT surgery
About 43030: Cricopharyngeal muscle myotomy
Reports surgical division of the cricopharyngeus to address upper esophageal sphincter dysfunction, such as persistent dysphagia from impaired muscle opening.
The surgeon divides the cricopharyngeus, the muscle at the upper esophageal sphincter, to relieve impaired opening that causes swallowing difficulty. Otolaryngologists and thoracic surgeons may perform the operation in a hospital setting for selected patients with cricopharyngeal dysfunction. A myotomy may also be part of surgery for a Zenker diverticulum, but when the diverticulum is excised, code 43130 includes the myotomy when performed.
Report 43030 when the operative work is a cricopharyngeal myotomy rather than excision of a diverticulum or a different esophageal incision. The operative report should identify the muscle treated, the surgical approach, and the reason for the procedure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 43030
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.79 · 56%
- Practice expense (office) RVU4.96 · 36%
- Malpractice RVU1.22 · 9%
461
Medicare services in 2024 · #3632 by national volume
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.
43030 compared with similar codes
Office rates for Austin, from the same CMS release.
43020 describes an incision of the esophagus. Code 43030 when the operative target is the cricopharyngeus muscle.
Unlisted procedure esophagus
43499 is for an esophageal procedure without a specific listed code. Use 43030 when the documented operation is a cricopharyngeal myotomy.
The same code, a different location
How does Austin compare?
43030 across payment areas
Same release and payment basis · bars start at $0
Austin · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Rest Of Texas
Texas · 43030
Office
Unavailable
Facility
$454.21
No comparable office rate is available.
Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)
California · 43030
Office
Unavailable
Facility
$493.90
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 43030
Office
Unavailable
Facility
$514.75
No comparable office rate is available.
Miami
Florida · 43030
Office
Unavailable
Facility
$535.71
No comparable office rate is available.
Chicago
Illinois · 43030
Office
Unavailable
Facility
$522.03
No comparable office rate is available.
Manhattan
New York · 43030
Office
Unavailable
Facility
$533.98
No comparable office rate is available.
Alaska*
Alaska · 43030
Office
Unavailable
Facility
$589.18
No comparable office rate is available.
Alabama
Alabama · 43030
Office
Unavailable
Facility
$428.22
No comparable office rate is available.
Arkansas
Arkansas · 43030
Office
Unavailable
Facility
$423.49
No comparable office rate is available.
Arizona
Arizona · 43030
Office
Unavailable
Facility
$455.61
No comparable office rate is available.
Bakersfield
California · 43030
Office
Unavailable
Facility
$471.53
No comparable office rate is available.
Chico
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
El Centro
California · 43030
Office
Unavailable
Facility
$468.23
No comparable office rate is available.
Fresno
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Hanford-Corcoran
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Madera
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Merced
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Modesto
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Napa
California · 43030
Office
Unavailable
Facility
$515.64
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 43030
Office
Unavailable
Facility
$488.69
No comparable office rate is available.
Redding
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Rest Of California
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 43030
Office
Unavailable
Facility
$481.21
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 43030
Office
Unavailable
Facility
$484.07
No comparable office rate is available.
Salinas
California · 43030
Office
Unavailable
Facility
$482.11
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 43030
Office
Unavailable
Facility
$488.22
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 43030
Office
Unavailable
Facility
$537.21
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 43030
Office
Unavailable
Facility
$535.82
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 43030
Office
Unavailable
Facility
$549.55
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 43030
Office
Unavailable
Facility
$543.89
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 43030
Office
Unavailable
Facility
$475.15
No comparable office rate is available.
Santa Cruz-Watsonville
California · 43030
Office
Unavailable
Facility
$488.79
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 43030
Office
Unavailable
Facility
$482.49
No comparable office rate is available.
Santa Rosa-Petaluma
California · 43030
Office
Unavailable
Facility
$493.28
No comparable office rate is available.
Stockton
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Vallejo
California · 43030
Office
Unavailable
Facility
$513.64
No comparable office rate is available.
Visalia
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Yuba City
California · 43030
Office
Unavailable
Facility
$468.03
No comparable office rate is available.
Colorado
Colorado · 43030
Office
Unavailable
Facility
$471.41
No comparable office rate is available.
Connecticut
Connecticut · 43030
Office
Unavailable
Facility
$493.13
No comparable office rate is available.
Delaware
Delaware · 43030
Office
Unavailable
Facility
$461.81
No comparable office rate is available.
Fort Lauderdale
Florida · 43030
Office
Unavailable
Facility
$501.69
No comparable office rate is available.
Rest Of Florida
Florida · 43030
Office
Unavailable
Facility
$479.82
No comparable office rate is available.
Atlanta
Georgia · 43030
Office
Unavailable
Facility
$478.23
No comparable office rate is available.
Rest Of Georgia
Georgia · 43030
Office
Unavailable
Facility
$456.54
No comparable office rate is available.
Hawaii, Guam
Hawaii · 43030
Office
Unavailable
Facility
$472.15
No comparable office rate is available.
Iowa
Iowa · 43030
Office
Unavailable
Facility
$427.96
No comparable office rate is available.
Idaho
Idaho · 43030
Office
Unavailable
Facility
$431.88
No comparable office rate is available.
East St. Louis
Illinois · 43030
Office
Unavailable
Facility
$494.68
No comparable office rate is available.
Rest Of Illinois
Illinois · 43030
Office
Unavailable
Facility
$475.14
No comparable office rate is available.
Suburban Chicago
Illinois · 43030
Office
Unavailable
Facility
$504.36
No comparable office rate is available.
Indiana
Indiana · 43030
Office
Unavailable
Facility
$433.57
No comparable office rate is available.
Kansas
Kansas · 43030
Office
Unavailable
Facility
$430.49
No comparable office rate is available.
Kentucky
Kentucky · 43030
Office
Unavailable
Facility
$444.76
No comparable office rate is available.
New Orleans
Louisiana · 43030
Office
Unavailable
Facility
$462.38
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 43030
Office
Unavailable
Facility
$445.85
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 43030
Office
Unavailable
Facility
$504.94
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 43030
Office
Unavailable
Facility
$471.28
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 43030
Office
Unavailable
Facility
$492.52
No comparable office rate is available.
Rest Of Maryland
Maryland · 43030
Office
Unavailable
Facility
$467.86
No comparable office rate is available.
Rest Of Maine
Maine · 43030
Office
Unavailable
Facility
$437.95
No comparable office rate is available.
Southern Maine
Maine · 43030
Office
Unavailable
Facility
$450.08
No comparable office rate is available.
Detroit
Michigan · 43030
Office
Unavailable
Facility
$488.77
No comparable office rate is available.
Rest Of Michigan
Michigan · 43030
Office
Unavailable
Facility
$457.45
No comparable office rate is available.
Minnesota
Minnesota · 43030
Office
Unavailable
Facility
$442.73
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 43030
Office
Unavailable
Facility
$455.57
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 43030
Office
Unavailable
Facility
$458.74
No comparable office rate is available.
Rest Of Missouri
Missouri · 43030
Office
Unavailable
Facility
$442.69
No comparable office rate is available.
Mississippi
Mississippi · 43030
Office
Unavailable
Facility
$432.95
No comparable office rate is available.
Montana**
Montana · 43030
Office
Unavailable
Facility
$466.53
No comparable office rate is available.
North Carolina
North Carolina · 43030
Office
Unavailable
Facility
$440.80
No comparable office rate is available.
North Dakota**
North Dakota · 43030
Office
Unavailable
Facility
$442.41
No comparable office rate is available.
Nebraska
Nebraska · 43030
Office
Unavailable
Facility
$428.51
No comparable office rate is available.
New Hampshire
New Hampshire · 43030
Office
Unavailable
Facility
$468.31
No comparable office rate is available.
Northern Nj
New Jersey · 43030
Office
Unavailable
Facility
$512.28
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 43030
Office
Unavailable
Facility
$496.21
No comparable office rate is available.
New Mexico
New Mexico · 43030
Office
Unavailable
Facility
$461.05
No comparable office rate is available.
Nevada**
Nevada · 43030
Office
Unavailable
Facility
$459.97
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 43030
Office
Unavailable
Facility
$549.50
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 43030
Office
Unavailable
Facility
$502.62
No comparable office rate is available.
Queens
New York · 43030
Office
Unavailable
Facility
$531.43
No comparable office rate is available.
Rest Of New York
New York · 43030
Office
Unavailable
Facility
$446.22
No comparable office rate is available.
Ohio
Ohio · 43030
Office
Unavailable
Facility
$452.52
No comparable office rate is available.
Oklahoma
Oklahoma · 43030
Office
Unavailable
Facility
$439.80
No comparable office rate is available.
Portland
Oregon · 43030
Office
Unavailable
Facility
$478.73
No comparable office rate is available.
Rest Of Oregon
Oregon · 43030
Office
Unavailable
Facility
$453.85
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 43030
Office
Unavailable
Facility
$485.95
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 43030
Office
Unavailable
Facility
$450.78
No comparable office rate is available.
Puerto Rico
Puerto Rico · 43030
Office
Unavailable
Facility
$467.82
No comparable office rate is available.
Rhode Island
Rhode Island · 43030
Office
Unavailable
Facility
$472.62
No comparable office rate is available.
South Carolina
South Carolina · 43030
Office
Unavailable
Facility
$447.91
No comparable office rate is available.
South Dakota**
South Dakota · 43030
Office
Unavailable
Facility
$439.55
No comparable office rate is available.
Tennessee
Tennessee · 43030
Office
Unavailable
Facility
$432.67
No comparable office rate is available.
Utah
Utah · 43030
Office
Unavailable
Facility
$452.51
No comparable office rate is available.
Virginia
Virginia · 43030
Office
Unavailable
Facility
$451.81
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 43030
Office
Unavailable
Facility
$467.82
No comparable office rate is available.
Vermont
Vermont · 43030
Office
Unavailable
Facility
$444.82
No comparable office rate is available.
Rest Of Washington
Washington · 43030
Office
Unavailable
Facility
$469.03
No comparable office rate is available.
Seattle (King Cnty)
Washington · 43030
Office
Unavailable
Facility
$509.77
No comparable office rate is available.
Wisconsin
Wisconsin · 43030
Office
Unavailable
Facility
$431.45
No comparable office rate is available.
West Virginia
West Virginia · 43030
Office
Unavailable
Facility
$462.47
No comparable office rate is available.
Wyoming**
Wyoming · 43030
Office
Unavailable
Facility
$456.02
No comparable office rate is available.
See how rates vary across the country
43030 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
- 43030 in Austin
Multiple payment areas
- 43030 in Barton Creek
- 43030 in Bee Cave
- 43030 in Briarcliff
- 43030 in Cedar Park
Multiple payment areas
- 43030 in Creedmoor
Multiple payment areas
- 43030 in Elgin
Multiple payment areas
- 43030 in Garfield
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 43030 in Austin. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$519.30
$472.09 × 110% = $519.30
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43030 in Austin.
PPRRVU2026_Oct_nonQPP.csv
5,112
- Code
- 43030
- Physician work
- 7.79
- Practice expense
- 4.96
- Malpractice
- 1.22
GPCI2026.csv
96
- Locality
- Austin
- Physician work
- 1.002
- Practice expense
- 1.058
- Malpractice
- 0.886
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.79 | × 1.002 | 7.8056 |
| Practice expense | 4.96 | × 1.058 | 5.2477 |
| Malpractice | 1.22 | × 0.886 | 1.0809 |
| Total RVUs | 14.1342 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Austin$472.09
Open 43030 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.79 | 1.002 |
| Practice expense | 4.96 | 1.058 |
| Malpractice | 1.22 | 0.886 |
(7.79 × 1.002 + 4.96 × 1.058 + 1.22 × 0.886) × $33.4009 = $472.09
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
43030 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $472.09 | RVU26D |
| 2026-07-01 | Not available in this setting | $472.09 | RVU26C |
| 2026-04-01 | Not available in this setting | $472.09 | RVU26B |
| 2026-01-01 | Not available in this setting | $472.09 | RVU26A |
| 2025-10-01 | Not available in this setting | $521.12 | RVU25D |
| 2025-07-01 | Not available in this setting | $521.12 | RVU25C |
| 2025-04-01 | Not available in this setting | $521.12 | RVU25B |
| 2025-01-01 | Not available in this setting | $521.12 | RVU25A |
43030 billing questions
Should 43030 or 43130 be reported for Zenker diverticulum surgery?
Use 43130 when the surgeon excises a hypopharyngeal or cervical esophageal diverticulum; that code includes a myotomy when performed. Report 43030 for a cricopharyngeal myotomy without diverticulum excision.
Can the myotomy be billed separately when performed with diverticulum excision?
No. When the surgeon excises the diverticulum and performs the myotomy as part of that operation, the myotomy is included in 43130.
What documentation supports 43030?
The operative report should identify division of the cricopharyngeus and document the clinical reason, such as impaired upper esophageal sphincter opening associated with dysphagia.
Can modifier 50 be appended?
No. The code's anatomy and descriptor make bilateral adjustment inappropriate, so modifier 50 is not used.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple procedure reduction. The code has a 90-day global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
