Billing code 43121: Partial esophagectomyMedicare rate & RVUs in Ohio
Reports partial esophageal resection through a thoracotomy and separate abdominal incision, with reconstruction connecting the remaining esophagus to the stomach.
CMS doesn’t publish an office rate for 43121 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 43121 covers
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.
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 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $2,631.57 |
How the 43121 rate is calculated
Each of 43121’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 · 43121
RVUs × geographic indexes × conversion factor
Work50.14
50.14 RVUs× 1.000 GPCI
Practice expense17.40
17.40 RVUs× 1.000 GPCI
Malpractice12.66
12.66 RVUs× 1.000 GPCI
Adjusted RVUs
80.2000
Conversion factor
$33.4009
Medicare rate
$2,678.75
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43121
43121 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43121
Partial esophagectomy
| 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) | 2 | Permitted. |
| 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 · 43121
Partial esophagectomy
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
43121 without 51 · national facility
$2,678.75
Partial esophagectomy
43121-51 · Second procedure: 50%
$1,339.38
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%).
43121 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43100Esophageal excision
- 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.
- 43107Esophagectomy
- 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.
- 43122Esophagectomy
- 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.
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 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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