No office rate
Both address esophageal diverticula through open surgery; 43130 uses a cervical approach, while 43135 uses a thoracic approach.
On this page
CMS RVU26D · Effective 2026-10-01
43130 Pouch excision Medicare reimbursement rates in Connecticut
Reports open cervical removal of an esophageal diverticulum with partial esophageal resection, commonly for a symptomatic pouch such as Zenker diverticulum. Compare 43130 office and facility rates across CMS payment localities in Connecticut.
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 43130 in Connecticut?
Connecticut 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
$756.05
1 of 1 localities have a supported rate.
Payment area: Connecticut
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.
Esophageal surgery
About 43130: Open cervical esophageal pouch excision
Reports open cervical removal of an esophageal diverticulum with partial esophageal resection, commonly for a symptomatic pouch such as Zenker diverticulum.
This operation removes an esophageal diverticular pouch through a neck incision and includes partial esophageal resection. It is commonly used for a symptomatic cervical pouch, such as Zenker diverticulum, when an open approach is selected. Otolaryngologists and thoracic surgeons typically perform it in a hospital operating room or other surgical facility. Symptoms prompting treatment may include difficulty swallowing, regurgitation, or aspiration related to the pouch.
Report 43130 for the cervical open approach, not for endoscopic treatment or a thoracic approach. The operative report should identify the diverticulum, the cervical route, and the extent of resection. Medicare applies a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation. Team surgery is not permitted.
CMS billing rules for 43130
- 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 RVU12.22 · 57%
- Practice expense (office) RVU6.95 · 32%
- Malpractice RVU2.22 · 10%
497
Medicare services in 2024 · #3570 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.
43130 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
43180 treats a pouch transorally with rigid esophagoscopy. Use 43130 for the open cervical operation.
Compare 43130 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$756.05
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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 43130 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,129
- Code
- 43130
- Physician work
- 12.22
- Practice expense
- 6.95
- Malpractice
- 2.22
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.22 | × 1.020 | 12.4644 |
| Practice expense | 6.95 | × 1.077 | 7.4851 |
| Malpractice | 2.22 | × 1.210 | 2.6862 |
| Total RVUs | 22.6358 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$756.05
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.22 | 1.02 |
| Practice expense | 6.95 | 1.077 |
| Malpractice | 2.22 | 1.21 |
(12.22 × 1.02 + 6.95 × 1.077 + 2.22 × 1.21) × $33.4009 = $756.05
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.
43130 billing questions
When should 43130 be chosen over 43135?
Choose 43130 for open removal through a cervical approach. Code 43135 is the thoracic-approach counterpart.
How does 43130 differ from 43180?
43130 describes open cervical surgery. Code 43180 is an endoscopic transoral approach using rigid esophagoscopy.
What documentation supports 43130?
The operative report should establish the esophageal diverticulum, the open cervical approach, and the resection performed.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
5,12643122,,Partial removal of esophagus,A,,43.08,16.00,NA,16.00,,10.87,69.95,69.95,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12743123,,Partial removal of esophagus,A,,81.04,23.52,NA,23.52,,20.45,125.01,125.01,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12843124,,Removal of esophagus,A,,67.36,22.05,NA,22.05,,16.98,106.39,106.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12943130,,Removal of esophagus pouch,A,,12.22,6.95,NA,6.95,,2.22,21.39,21.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13043135,,Removal of esophagus pouch,A,,25.52,9.62,NA,9.62,,6.43,41.57,41.57,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13143180,,Esophagoscopy rigid trnso,A,,8.80,4.23,NA,4.23,,1.31,14.34,14.34,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13243191,,Esophagoscopy rigid trnso dx,A,,2.43,1.26,NA,1.26,,0.37,4.06,4.06,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808