Billing code 43180: DiverticulotomyMedicare rate & RVUs in Oregon
Rigid transoral esophagoscopy with endoscopic division of a hypopharyngeal or cervical esophageal diverticulum, typically to treat Zenker's diverticulum.
CMS doesn’t publish an office rate for 43180 in Oregon.
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 43180 covers
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.
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.
Where 43180 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $488.15 |
| Rest Of Oregon | Unavailable | $465.41 |
How the 43180 rate is calculated
Each of 43180’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 · 43180
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.80Practice expense 4.23Malpractice 1.31
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43180
43180 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43180
Diverticulotomy
| 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not 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 · 43180
Diverticulotomy
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
43180 without 51 · national facility
$478.97
Diverticulotomy
43180-51 · Second procedure: 50%
$239.49
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%).
43180 compared with similar codes
Compare codes
43180 vs 43130 vs 43191 vs 43193: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43130Pouch excision
- 43130 describes open removal of an esophageal pouch. This code describes endoscopic division of the diverticular septum through a rigid transoral scope.
- 43191Esophagoscopy
- 43191 is a rigid transoral diagnostic examination. Report this code when the session includes endoscopic diverticulotomy, not merely diagnostic esophagoscopy.
- 43193Esophagoscopy
- 43193 describes rigid transoral esophagoscopy with biopsy. It is for tissue sampling, not endoscopic division of a diverticular septum.
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 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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