Billing code 43020: Esophageal incisionMedicare rate & RVUs in Guam
Reports an open incision into the cervical esophagus when operative treatment requires direct access through the neck rather than endoscopic access.
CMS doesn’t publish an office rate for 43020 in Guam.
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 43020 covers
This service involves surgically opening the esophagus through a cervical approach. It is performed by a surgeon when the operative plan requires direct access to the neck portion of the esophagus; it is distinct from an endoscopic procedure performed through the mouth. The operative report should identify the cervical approach and describe the esophageal incision and its purpose.
Report the code for the cervical esophageal incision, not for a cricopharyngeal muscle procedure or a thoracic approach. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When 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 not appropriate for this descriptor and anatomy. An assistant at surgery may be paid; 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.
43020 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $550.79 |
How the 43020 rate is calculated
Each of 43020’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 · 43020
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.02Practice expense 6.36Malpractice 2.14
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43020
43020 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43020
Esophageal incision
| 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 · 43020
Esophageal incision
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
43020 without 51 · national facility
$551.78
Esophageal incision
43020-51 · Second procedure: 50%
$275.89
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%).
43020 compared with similar codes
Compare codes
43020 vs 43045 vs 43030 vs 43215: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43045Esophagotomy
- Use this code for a cervical esophageal incision. Code 43045 describes a thoracic approach with foreign-body removal.
- 43030Cricopharyngeal myotomy
- Code 43030 is a cricopharyngeal myotomy directed at the muscle; this code describes an incision into the esophagus.
- 43215Object removal
- Code 43215 reports transoral endoscopic foreign-body removal. This code is for an open incision through a cervical approach.
43020 billing questions
How does this differ from 43045?
This code describes an esophageal incision by a cervical approach. Code 43045 describes a thoracic approach with foreign-body removal.
Is this the same as a cricopharyngeal myotomy?
No. Code 43030 addresses the cricopharyngeal muscle; this service is an incision into the esophagus through the neck.
Can an endoscopic foreign-body removal be reported instead?
When the foreign body is removed endoscopically, consider the applicable endoscopic removal code, such as 43215 or 43247, rather than an open cervical incision.
What documentation supports reporting this code?
Document the cervical surgical approach, the esophageal incision, and the operative reason for direct access. The operative note should distinguish the esophageal incision from work limited to the cricopharyngeal muscle.
Can modifier 50 be used for a bilateral procedure?
No. Modifier 50 is not appropriate for this code's descriptor and anatomy.
What postoperative care is included?
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 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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