Billing code 43030: Cricopharyngeal myotomyMedicare rate & RVUs in Utah
Reports surgical division of the cricopharyngeus to address upper esophageal sphincter dysfunction, such as persistent dysphagia from impaired muscle opening.
CMS doesn’t publish an office rate for 43030 in Utah.
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 43030 covers
The surgeon divides the cricopharyngeus, the muscle at the upper esophageal sphincter, to relieve impaired opening that causes swallowing difficulty. Otolaryngologists and thoracic surgeons may perform the operation in a hospital setting for selected patients with cricopharyngeal dysfunction. A myotomy may also be part of surgery for a Zenker diverticulum, but when the diverticulum is excised, code 43130 includes the myotomy when performed.
Report 43030 when the operative work is a cricopharyngeal myotomy rather than excision of a diverticulum or a different esophageal incision. The operative report should identify the muscle treated, the surgical approach, and the reason for the procedure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and 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.
43030 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $452.51 |
How the 43030 rate is calculated
Each of 43030’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 · 43030
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.79Practice expense 4.96Malpractice 1.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43030
43030 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43030
Cricopharyngeal myotomy
| 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 · 43030
Cricopharyngeal myotomy
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
43030 without 51 · national facility
$466.61
Cricopharyngeal myotomy
43030-51 · Second procedure: 50%
$233.31
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%).
43030 compared with similar codes
Compare codes
43030 vs 43130 vs 43020 vs 43499: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43130Pouch excision
- Choose 43130 when the operation excises a hypopharyngeal or cervical esophageal diverticulum; its descriptor includes myotomy when performed. Use 43030 for myotomy without diverticulum excision.
- 43020Esophageal incision
- 43020 describes an incision of the esophagus. Code 43030 when the operative target is the cricopharyngeus muscle.
- 43499Unlisted procedure esophagus
- 43499 is for an esophageal procedure without a specific listed code. Use 43030 when the documented operation is a cricopharyngeal myotomy.
43030 billing questions
Should 43030 or 43130 be reported for Zenker diverticulum surgery?
Use 43130 when the surgeon excises a hypopharyngeal or cervical esophageal diverticulum; that code includes a myotomy when performed. Report 43030 for a cricopharyngeal myotomy without diverticulum excision.
Can the myotomy be billed separately when performed with diverticulum excision?
No. When the surgeon excises the diverticulum and performs the myotomy as part of that operation, the myotomy is included in 43130.
What documentation supports 43030?
The operative report should identify division of the cricopharyngeus and document the clinical reason, such as impaired upper esophageal sphincter opening associated with dysphagia.
Can modifier 50 be appended?
No. The code's anatomy and descriptor make bilateral adjustment inappropriate, so modifier 50 is not used.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple procedure reduction. The code has a 90-day global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery 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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