Billing code 43286: EsophagectomyMedicare rate & RVUs in Utah
Reports laparoscopic total removal of the esophagus, including thoracic portions, with laparoscopic mobilization of the esophagus and stomach and no thoracotomy.
CMS doesn’t publish an office rate for 43286 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 43286 covers
This service covers total removal of the esophagus using a laparoscopic approach, including laparoscopic mobilization of the esophagus and stomach. It is commonly performed by thoracic or gastrointestinal surgeons in a hospital operating room, often for esophageal cancer requiring resection beyond a distal segment. The code’s scope specifies that the thoracic esophagus is included and that the operation is performed without thoracotomy.
Choose this code when the operative report supports total esophagectomy and the specified laparoscopic approach; a distal two-thirds resection is a different service. Documentation should establish the extent of resection, the approach, and the mobilization performed. The 90-day global period includes the day-before preoperative visit and related postoperative care during that period. When 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. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery payment 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.
43286 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $2,856.82 |
How the 43286 rate is calculated
Each of 43286’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 · 43286
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 53.63Practice expense 20.84Malpractice 13.71
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43286
43286 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43286
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) | 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 · 43286
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
43286 without 51 · national facility
$2,945.29
Esophagectomy
43286-51 · Second procedure: 50%
$1,472.65
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%).
43286 compared with similar codes
Compare codes
43286 vs 43287 vs 43288 vs 43107: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43287Esophagectomy
- 43287 applies to laparoscopic resection of the distal two-thirds of the esophagus. Use 43286 for a total esophagectomy meeting its approach requirements.
- 43288Esophagectomy
- 43288 is the related thoracic esophagectomy service with laparoscopic mobilization. Select based on the operation and approach documented, rather than treating it as a total laparoscopic resection.
- 43107Esophagectomy
- 43107 represents an open total or near-total esophagectomy involving thoracotomy. This code is for the specified laparoscopic total esophagectomy performed without thoracotomy.
43286 billing questions
How do I choose this code instead of 43287?
Use 43286 when the surgeon performs a total esophagectomy by the specified laparoscopic approach. Code 43287 describes resection limited to the distal two-thirds.
Is laparoscopic mobilization separately reported?
The laparoscopic mobilization of the esophagus and stomach is part of this service. It is not separately reported as an additional mobilization procedure.
What documentation supports co-surgeon billing?
The operative record should support the distinct co-surgeon roles and the need for both surgeons. CMS permits co-surgeon payment only with supporting documentation.
Can an assistant surgeon be paid?
Yes. CMS permits assistant-at-surgery payment for this code; the claim and operative documentation should reflect the assistant’s role.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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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