No office rate
43130 describes open removal of an esophageal pouch. This code describes endoscopic division of the diverticular septum through a rigid transoral scope.
On this page
CMS RVU26D · Effective 2026-10-01
43180 Diverticulotomy Medicare reimbursement rates in Nebraska
Rigid transoral esophagoscopy with endoscopic division of a hypopharyngeal or cervical esophageal diverticulum, typically to treat Zenker's diverticulum. Compare 43180 office and facility rates across CMS payment localities in Nebraska.
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 43180 in Nebraska?
Nebraska 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
$440.87
1 of 1 localities have a supported rate.
Payment area: Nebraska
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 43180: Rigid endoscopic Zenker diverticulotomy
Rigid transoral esophagoscopy with endoscopic division of a hypopharyngeal or cervical esophageal diverticulum, typically to treat Zenker's diverticulum.
This service treats a hypopharyngeal or cervical esophageal diverticulum, most commonly a Zenker's diverticulum. The surgeon passes a rigid esophagoscope through the mouth and divides the tissue septum separating the pouch from the esophageal lumen. Otolaryngologists and thoracic surgeons typically perform the operation in a hospital operating room under anesthesia.
Report this code when the rigid transoral approach is used to perform the endoscopic diverticulotomy; documentation should identify the diverticulum, approach, and septum division. The procedure has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. If 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 inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43180
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.80 · 61%
- Practice expense (office) RVU4.23 · 29%
- Malpractice RVU1.31 · 9%
899
Medicare services in 2024 · #3043 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.
43180 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
43191 is a rigid transoral diagnostic examination. Report this code when the session includes endoscopic diverticulotomy, not merely diagnostic esophagoscopy.
No office rate
43193 describes rigid transoral esophagoscopy with biopsy. It is for tissue sampling, not endoscopic division of a diverticular septum.
Compare 43180 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
Nebraska →
Office / nonfacility
Unavailable
Facility
$440.87
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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 43180 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
5,131
- Code
- 43180
- Physician work
- 8.80
- Practice expense
- 4.23
- Malpractice
- 1.31
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.80 | × 1.000 | 8.8000 |
| Practice expense | 4.23 | × 0.923 | 3.9043 |
| Malpractice | 1.31 | × 0.378 | 0.4952 |
| Total RVUs | 13.1995 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nebraska$440.87
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.8 | 1 |
| Practice expense | 4.23 | 0.923 |
| Malpractice | 1.31 | 0.378 |
(8.8 × 1 + 4.23 × 0.923 + 1.31 × 0.378) × $33.4009 = $440.87
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.
43180 billing questions
When is the rigid approach used instead of flexible diverticulotomy?
This code is for endoscopic diverticulotomy performed with a rigid esophagoscope passed through the mouth. Flexible transoral diverticulotomy is reported with 43181.
How does this differ from open pouch surgery?
This code describes endoscopic division of the diverticular septum through a rigid scope. Code 43130 is an open operation to remove an esophageal pouch.
What documentation supports reporting this code?
The operative report should identify the hypopharyngeal or cervical esophageal diverticulum, the rigid transoral approach, and the endoscopic division of the septum.
Can modifier 50 be used for a diverticulum on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code's descriptor and anatomy.
How does the multiple-procedure reduction affect another procedure performed in the same session?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard 50% reduction.
Can an assistant surgeon or co-surgeon be paid for this service?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are 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.
5,12843124,,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
5,13343192,,Esophagoscp rig trnso inject,A,,2.72,1.28,NA,1.28,,0.40,4.40,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
5,13443193,,Esophagoscp rig trnso biopsy,A,,2.72,1.30,NA,1.30,,0.41,4.43,4.43,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068