Billing code 43130: Pouch excisionMedicare rate & RVUs in Texas
Reports open cervical removal of an esophageal diverticulum with partial esophageal resection, commonly for a symptomatic pouch such as Zenker diverticulum.
CMS doesn’t publish an office rate for 43130 in Texas.
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 43130 covers
This operation removes an esophageal diverticular pouch through a neck incision and includes partial esophageal resection. It is commonly used for a symptomatic cervical pouch, such as Zenker diverticulum, when an open approach is selected. Otolaryngologists and thoracic surgeons typically perform it in a hospital operating room or other surgical facility. Symptoms prompting treatment may include difficulty swallowing, regurgitation, or aspiration related to the pouch.
Report 43130 for the cervical open approach, not for endoscopic treatment or a thoracic approach. The operative report should identify the diverticulum, the cervical route, and the extent of resection. Medicare applies a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation. 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.
Where 43130 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $720.27 |
| Beaumont | Unavailable | $688.29 |
| Brazoria | Unavailable | $699.31 |
| Dallas | Unavailable | $706.66 |
| Fort Worth | Unavailable | $705.30 |
| Galveston | Unavailable | $703.33 |
| Houston | Unavailable | $743.97 |
| Rest Of Texas | Unavailable | $695.41 |
How the 43130 rate is calculated
Each of 43130’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 · 43130
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.22Practice expense 6.95Malpractice 2.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43130
43130 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43130
Pouch 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 · 43130
Pouch 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
43130 without 51 · national facility
$714.45
Pouch excision
43130-51 · Second procedure: 50%
$357.23
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%).
43130 compared with similar codes
Compare codes
43130 vs 43135 vs 43180: national Medicare rates
Swap in your local Medicare rate.
How to choose
43130 billing questions
When should 43130 be chosen over 43135?
Choose 43130 for open removal through a cervical approach. Code 43135 is the thoracic-approach counterpart.
How does 43130 differ from 43180?
43130 describes open cervical surgery. Code 43180 is an endoscopic transoral approach using rigid esophagoscopy.
What documentation supports 43130?
The operative report should establish the esophageal diverticulum, the open cervical approach, and the resection performed.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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