No office rate
43100 describes excision of an esophageal lesion with primary repair. Choose 43121 when the surgeon performs partial esophagectomy through a thoracotomy and separate abdominal incision with esophagogastrostomy.
On this page
CMS RVU26D · Effective 2026-10-01
43121 Partial esophagectomy Medicare reimbursement rates in Idaho
Reports partial esophageal resection through a thoracotomy and separate abdominal incision, with reconstruction connecting the remaining esophagus to the stomach. Compare 43121 office and facility rates across CMS payment localities in Idaho.
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 43121 in Idaho?
Idaho 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
$2409.41
1 of 1 localities have a supported rate.
Payment area: Idaho
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 43121: Partial esophagectomy with esophagogastrostomy
Reports partial esophageal resection through a thoracotomy and separate abdominal incision, with reconstruction connecting the remaining esophagus to the stomach.
A thoracic or general surgeon removes part of the esophagus through a chest incision and a separate abdominal incision. The operation may also remove the proximal stomach, and the reconstruction joins the remaining esophagus to the stomach. Esophageal cancer is a typical reason for this operation. It is generally performed in a hospital operating room rather than an office setting.
Select this code when the operative report supports partial esophagectomy by the specified approaches and esophagogastrostomy. Documentation should identify the resected portion, thoracotomy and separate abdominal incision, any proximal gastrectomy, and the reconstruction performed. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment and co-surgeons are permitted; team-surgery billing is not permitted.
CMS billing rules for 43121
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU50.14 · 63%
- Practice expense (office) RVU17.40 · 22%
- Malpractice RVU12.66 · 16%
15
Medicare services in 2024 · #6073 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.
43121 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
43107 represents total or near-total esophagectomy without thoracotomy. 43121 is for partial resection using a thoracotomy and separate abdominal incision, with the esophagus joined to the stomach.
No office rate
Both are partial-esophagectomy family codes, but the reconstruction differs. Review the operative report for the conduit used rather than choosing by resection extent alone.
Compare 43121 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
Idaho →
Office / nonfacility
Unavailable
Facility
$2409.41
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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 43121 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
5,125
- Code
- 43121
- Physician work
- 50.14
- Practice expense
- 17.40
- Malpractice
- 12.66
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 50.14 | × 1.000 | 50.1400 |
| Practice expense | 17.40 | × 0.920 | 16.0080 |
| Malpractice | 12.66 | × 0.473 | 5.9882 |
| Total RVUs | 72.1362 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$2409.41
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 50.14 | 1 |
| Practice expense | 17.4 | 0.92 |
| Malpractice | 12.66 | 0.473 |
(50.14 × 1 + 17.4 × 0.92 + 12.66 × 0.473) × $33.4009 = $2409.41
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.
43121 billing questions
What distinguishes this code from nearby partial-esophagectomy codes?
Confirm the operative approach and reconstruction, not just the amount of esophagus removed. This code describes thoracotomy, a separate abdominal incision, and connection of the esophagus to the stomach.
Can a focal esophageal lesion excision be reported instead?
A lesion-excision code such as 43100 is for excising a lesion with primary repair. Use 43121 when the operation is a partial esophagectomy with the approaches and reconstruction documented for this code.
What documentation supports reporting 43121?
The operative report should establish the partial resection, thoracotomy, separate abdominal incision, and esophagogastrostomy. It should also state whether proximal stomach was removed.
How does the multiple-procedure reduction work?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction.
Can an assistant or co-surgeon be reported?
CMS permits assistant-at-surgery payment and co-surgeons for this code. Team-surgery billing 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.
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
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
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772