Billing code 43101: Esophageal lesion excisionMedicare rate & RVUs in Ohio
Open thoracic excision removes a localized esophageal lesion with primary repair when chest access is required and the remaining esophagus is preserved.
CMS doesn’t publish an office rate for 43101 in Ohio.
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 43101 covers
Code 43101 represents open removal of a localized esophageal lesion through a thoracic approach, with primary repair of the esophageal wall. A classic use is surgical enucleation of an esophageal leiomyoma when the surgeon opens the chest to reach the lesion while preserving the remaining esophagus. Thoracic surgeons typically perform this in an operating room under general anesthesia; it is not the code for a lesion sampled or removed endoscopically.
Report it when the operative documentation identifies the lesion, thoracic access, excision, and repair, and distinguishes the work from segmental or total esophagectomy. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, while 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.
43101 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $946.00 |
How the 43101 rate is calculated
Each of 43101’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 · 43101
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 16.64Practice expense 8.17Malpractice 4.19
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43101
43101 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43101
Esophageal lesion excision
| 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 · 43101
Esophageal lesion excision
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
43101 without 51 · national facility
$968.63
Esophageal lesion excision
43101-51 · Second procedure: 50%
$484.32
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%).
43101 compared with similar codes
Compare codes
43101 vs 43100 vs 43116 vs 43193: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43100Esophageal excision
- Use 43100 for lesion excision and repair through a cervical approach. Code 43101 describes the thoracic approach.
- 43116Esophagectomy
- Use 43101 for a localized lesion excision with repair; consider 43116 when the surgeon removes a partial segment of esophagus.
- 43193Esophagoscopy
- Code 43193 describes rigid transoral esophagoscopy with biopsy. It is for endoscopic tissue sampling, not open thoracic excision and repair.
43101 billing questions
How does 43101 differ from 43100?
Both describe excision of an esophageal lesion with repair, but 43101 is for a thoracic approach and 43100 is for a cervical approach. Use the approach documented in the operative report.
Is endoscopic biopsy included in 43101?
No. Code 43101 describes open thoracic lesion excision and repair; an endoscopic biopsy is a different service. Do not use the open excision code when the surgeon only samples the lesion endoscopically.
Can modifier 50 be reported?
No. The descriptor and anatomy make bilateral reporting with modifier 50 inappropriate for 43101.
What postoperative care is included?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
How are other procedures in the same session paid?
Medicare pays the highest-valued procedure in full and reduces other procedures in the same session to 50% under the standard multiple procedure rule.
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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