No office rate
The key distinction is the reconstruction: 43116 uses the stomach, while 43117 uses colon or small intestine.
On this page
CMS RVU26D · Effective 2026-10-01
43116 Esophagectomy Medicare reimbursement rates in Alabama
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. Compare 43116 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 43116 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$4148.39
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Thoracic surgery
About 43116: Distal two-thirds esophagectomy with stomach reconstruction
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.
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.
CMS billing rules for 43116
- 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 RVU90.67 · 66%
- Practice expense (office) RVU23.52 · 17%
- Malpractice RVU22.88 · 17%
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.
43116 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
43107 describes total or near-total esophagectomy without thoracotomy. Choose 43116 for the specified distal partial resection with thoracic and separate abdominal access.
No office rate
43112 is for total or near-total esophagectomy with thoracotomy; 43116 is for partial resection of the distal two-thirds.
No office rate
43100 is for excising an esophageal lesion. Use 43116 when the documented operation removes the distal two-thirds and includes stomach reconstruction.
Compare 43116 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$4148.39
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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 43116 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
5,122
- Code
- 43116
- Physician work
- 90.67
- Practice expense
- 23.52
- Malpractice
- 22.88
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 90.67 | × 1.000 | 90.6700 |
| Practice expense | 23.52 | × 0.875 | 20.5800 |
| Malpractice | 22.88 | × 0.566 | 12.9501 |
| Total RVUs | 124.2001 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$4148.39
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 90.67 | 1 |
| Practice expense | 23.52 | 0.875 |
| Malpractice | 22.88 | 0.566 |
(90.67 × 1 + 23.52 × 0.875 + 22.88 × 0.566) × $33.4009 = $4148.39
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.
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 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.
5,11943108,,Removal of esophagus,A,,80.80,21.57,NA,21.57,,20.37,122.74,122.74,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12043112,,Esphg tot w/thrcm,A,,60.45,20.08,NA,20.08,,15.24,95.77,95.77,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12143113,,Removal of esophagus,A,,78.06,22.93,NA,22.93,,19.70,120.69,120.69,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12243116,,Partial removal of esophagus,A,,90.67,23.52,NA,23.52,,22.88,137.07,137.07,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12343117,,Partial removal of esophagus,A,,56.06,20.48,NA,20.48,,14.13,90.67,90.67,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12443118,,Partial removal of esophagus,A,,65.39,18.54,NA,18.54,,16.49,100.42,100.42,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12543121,,Partial removal of esophagus,A,,50.14,17.40,NA,17.40,,12.66,80.20,80.20,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515