No office rate
Use 43100 for lesion excision and repair through a cervical approach. Code 43101 describes the thoracic approach.
On this page
CMS RVU26D · Effective 2026-10-01
43101 Esophageal lesion excision Medicare reimbursement rates in Utah
Open thoracic excision removes a localized esophageal lesion with primary repair when chest access is required and the remaining esophagus is preserved. Compare 43101 office and facility rates across CMS payment localities in Utah.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 43101 in Utah?
Utah has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$937.98
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Thoracic surgery
About 43101: Open thoracic esophageal lesion excision
Open thoracic excision removes a localized esophageal lesion with primary repair when chest access is required and the remaining esophagus is preserved.
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.
CMS billing rules for 43101
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU16.64 · 57%
- Practice expense (office) RVU8.17 · 28%
- Malpractice RVU4.19 · 14%
30
Medicare services in 2024 · #5672 by national volume
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 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
Use 43101 for a localized lesion excision with repair; consider 43116 when the surgeon removes a partial segment of esophagus.
No office rate
Code 43193 describes rigid transoral esophagoscopy with biopsy. It is for endoscopic tissue sampling, not open thoracic excision and repair.
Compare 43101 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Utah →
Office / nonfacility
Unavailable
Facility
$937.98
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43101 in Utah.
PPRRVU2026_Oct_nonQPP.csv
5,117
- Code
- 43101
- Physician work
- 16.64
- Practice expense
- 8.17
- Malpractice
- 4.19
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 16.64 | × 1.000 | 16.6400 |
| Practice expense | 8.17 | × 0.940 | 7.6798 |
| Malpractice | 4.19 | × 0.898 | 3.7626 |
| Total RVUs | 28.0824 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$937.98
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 16.64 | 1 |
| Practice expense | 8.17 | 0.94 |
| Malpractice | 4.19 | 0.898 |
(16.64 × 1 + 8.17 × 0.94 + 4.19 × 0.898) × $33.4009 = $937.98
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,1144305F,,Pt ed re ft care inspct rcvd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,1154306F,,Pt tlk psych & rx opd addic,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,11643100,,Excision of esophagus lesion,A,,9.42,5.93,NA,5.93,,1.36,16.71,16.71,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,11743101,,Excision of esophagus lesion,A,,16.64,8.17,NA,8.17,,4.19,29.00,29.00,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,11843107,,Removal of esophagus,A,,50.75,19.03,NA,19.03,,12.82,82.60,82.60,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,11943108,,Removal of esophagus,A,,80.80,21.57,NA,21.57,,20.37,122.74,122.74,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12043112,,Esphg tot w/thrcm,A,,60.45,20.08,NA,20.08,,15.24,95.77,95.77,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985