No office rate
Choose 43130 when the operation excises a hypopharyngeal or cervical esophageal diverticulum; its descriptor includes myotomy when performed. Use 43030 for myotomy without diverticulum excision.
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CMS RVU26D · Effective 2026-10-01
43030 Cricopharyngeal myotomy Medicare reimbursement rates in Minnesota
Reports surgical division of the cricopharyngeus to address upper esophageal sphincter dysfunction, such as persistent dysphagia from impaired muscle opening. Compare 43030 office and facility rates across CMS payment localities in Minnesota.
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 43030 in Minnesota?
Minnesota 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
$442.73
1 of 1 localities have a supported rate.
Payment area: Minnesota
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.
ENT surgery
About 43030: Cricopharyngeal muscle myotomy
Reports surgical division of the cricopharyngeus to address upper esophageal sphincter dysfunction, such as persistent dysphagia from impaired muscle opening.
The surgeon divides the cricopharyngeus, the muscle at the upper esophageal sphincter, to relieve impaired opening that causes swallowing difficulty. Otolaryngologists and thoracic surgeons may perform the operation in a hospital setting for selected patients with cricopharyngeal dysfunction. A myotomy may also be part of surgery for a Zenker diverticulum, but when the diverticulum is excised, code 43130 includes the myotomy when performed.
Report 43030 when the operative work is a cricopharyngeal myotomy rather than excision of a diverticulum or a different esophageal incision. The operative report should identify the muscle treated, the surgical approach, and the reason for the procedure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 43030
- 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 RVU7.79 · 56%
- Practice expense (office) RVU4.96 · 36%
- Malpractice RVU1.22 · 9%
461
Medicare services in 2024 · #3632 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.
43030 compared with similar codes
Office rates for Minnesota, from the same CMS release.
No office rate
43020 describes an incision of the esophagus. Code 43030 when the operative target is the cricopharyngeus muscle.
43499
No office rateUnlisted procedure esophagus
43499 is for an esophageal procedure without a specific listed code. Use 43030 when the documented operation is a cricopharyngeal myotomy.
Compare 43030 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
Minnesota →
Office / nonfacility
Unavailable
Facility
$442.73
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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 43030 in Minnesota.
PPRRVU2026_Oct_nonQPP.csv
5,112
- Code
- 43030
- Physician work
- 7.79
- Practice expense
- 4.96
- Malpractice
- 1.22
GPCI2026.csv
66
- Locality
- Minnesota
- Physician work
- 1.000
- Practice expense
- 1.029
- Malpractice
- 0.296
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.79 | × 1.000 | 7.7900 |
| Practice expense | 4.96 | × 1.029 | 5.1038 |
| Malpractice | 1.22 | × 0.296 | 0.3611 |
| Total RVUs | 13.2550 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Minnesota$442.73
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.79 | 1 |
| Practice expense | 4.96 | 1.029 |
| Malpractice | 1.22 | 0.296 |
(7.79 × 1 + 4.96 × 1.029 + 1.22 × 0.296) × $33.4009 = $442.73
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.
43030 billing questions
Should 43030 or 43130 be reported for Zenker diverticulum surgery?
Use 43130 when the surgeon excises a hypopharyngeal or cervical esophageal diverticulum; that code includes a myotomy when performed. Report 43030 for a cricopharyngeal myotomy without diverticulum excision.
Can the myotomy be billed separately when performed with diverticulum excision?
No. When the surgeon excises the diverticulum and performs the myotomy as part of that operation, the myotomy is included in 43130.
What documentation supports 43030?
The operative report should identify division of the cricopharyngeus and document the clinical reason, such as impaired upper esophageal sphincter opening associated with dysphagia.
Can modifier 50 be appended?
No. The code's anatomy and descriptor make bilateral adjustment inappropriate, so modifier 50 is not used.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple procedure reduction. The code has a 90-day global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery 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.
5,1094300F,,Pt rcvng warf thxpy,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,1104301F,,Pt not rcvng warf thxpy,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,11143020,,Incision of esophagus,A,,8.02,6.36,NA,6.36,,2.14,16.52,16.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,11243030,,Cricopharyngeal myotomy,A,,7.79,4.96,NA,4.96,,1.22,13.97,13.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,11343045,,Esophagotomy thrc rmvl fb,A,,21.33,10.98,NA,10.98,,5.37,37.68,37.68,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,1144305F,,Pt ed re ft care inspct rcvd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,1154306F,,Pt tlk psych & rx opd addic,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
6314212,MA,99,REST OF MASSACHUSETTS,1.016,1.053,0.797
6408202,MI,01,DETROIT,1.000,0.965,1.686
6508202,MI,99,REST OF MICHIGAN,1.000,0.913,1.129
6606202,MN,00,MINNESOTA,1.000,1.029,0.296
6707302,MS,00,MISSISSIPPI,1.000,0.861,0.739
6805302,MO,02,METROPOLITAN KANSAS CITY,1.000,0.939,0.977
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002