Billing code 43116: EsophagectomyMedicare rate & RVUs in Georgia
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.
CMS doesn’t publish an office rate for 43116 in Georgia.
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 9 sections
What 43116 covers
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.
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 43116 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | Unavailable | $4,753.52 |
| Rest Of Georgia | Unavailable | $4,640.15 |
How the 43116 rate is calculated
Each of 43116’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 · 43116
RVUs × geographic indexes × conversion factor
Work90.67
90.67 RVUs× 1.000 GPCI
Practice expense23.52
23.52 RVUs× 1.000 GPCI
Malpractice22.88
22.88 RVUs× 1.000 GPCI
Adjusted RVUs
137.0700
Conversion factor
$33.4009
Medicare rate
$4,578.26
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43116
43116 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43116
Esophagectomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43116
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43116 without 51 · national facility
$4,578.26
Esophagectomy
43116-51 · Second procedure: 50%
$2,289.13
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%).
43116 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43117Partial esophagectomy
- The key distinction is the reconstruction: 43116 uses the stomach, while 43117 uses colon or small intestine.
- 43107Esophagectomy
- 43107 describes total or near-total esophagectomy without thoracotomy. Choose 43116 for the specified distal partial resection with thoracic and separate abdominal access.
- 43112Esophagectomy
- 43112 is for total or near-total esophagectomy with thoracotomy; 43116 is for partial resection of the distal two-thirds.
- 43100Esophageal excision
- 43100 is for excising an esophageal lesion. Use 43116 when the documented operation removes the distal two-thirds and includes stomach reconstruction.
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 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
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