No office rate
Both describe partial esophagectomy variants involving an abdominal or thoracoabdominal approach. The reconstruction documented in the operative report distinguishes this code from 43121.
On this page
CMS RVU26D · Effective 2026-10-01
43122 Esophagectomy Medicare reimbursement rates in Vermont
Reports partial esophageal resection through an abdominal or thoracoabdominal approach when reconstruction uses colon interposition or jejunal transfer. Compare 43122 office and facility rates across CMS payment localities in Vermont.
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 43122 in Vermont?
Vermont 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
$2151.69
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Esophageal surgery
About 43122: Partial esophagectomy with intestinal reconstruction
Reports partial esophageal resection through an abdominal or thoracoabdominal approach when reconstruction uses colon interposition or jejunal transfer.
This code describes removal of part of the esophagus through an abdominal or thoracoabdominal approach, with reconstruction using a segment of colon or jejunum. It may be used for conditions such as esophageal cancer when the operative plan requires this extent of resection and reconstruction. The procedure is performed by a surgeon in a hospital operating room; Medicare claims for this code are reported in the facility setting.
Select the code from the operative report’s documented resection extent, surgical approach, any proximal stomach removal, and reconstruction method. The report should establish that colon interposition or jejunal transfer was used, rather than a different reconstruction captured by a sibling code. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43122
- 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 RVU43.08 · 62%
- Practice expense (office) RVU16.00 · 23%
- Malpractice RVU10.87 · 16%
89
Medicare services in 2024 · #4971 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.
43122 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
43117 represents a partial esophagectomy through a thoracic approach. This code is the abdominal or thoracoabdominal variant with colon interposition or jejunal transfer.
No office rate
43107 is for total or near-total esophageal removal; this code is for partial removal with the specified intestinal reconstruction.
No office rate
43100 describes excision of an esophageal lesion, not the partial esophagectomy and intestinal reconstruction reported with this code.
Compare 43122 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
Vermont →
Office / nonfacility
Unavailable
Facility
$2151.69
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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 43122 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,126
- Code
- 43122
- Physician work
- 43.08
- Practice expense
- 16.00
- Malpractice
- 10.87
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 43.08 | × 1.000 | 43.0800 |
| Practice expense | 16.00 | × 0.990 | 15.8400 |
| Malpractice | 10.87 | × 0.506 | 5.5002 |
| Total RVUs | 64.4202 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$2151.69
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 43.08 | 1 |
| Practice expense | 16 | 0.99 |
| Malpractice | 10.87 | 0.506 |
(43.08 × 1 + 16 × 0.99 + 10.87 × 0.506) × $33.4009 = $2151.69
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.
43122 billing questions
How is this code distinguished from 43121?
The operative approach and reconstruction determine the choice. This code represents the variant using colon interposition or jejunal transfer; 43121 describes a different reconstruction variant.
What operative details support reporting this code?
Document the portion of esophagus removed, abdominal or thoracoabdominal approach, any proximal gastrectomy, and whether colon or jejunum was used for reconstruction.
Can the intestinal reconstruction be reported separately?
The code includes the specified colon interposition or jejunal transfer as part of the esophagectomy service. Do not separately report that same reconstruction as though it were an independent service.
How does the 90-day global period affect postoperative claims?
The day-before preoperative visit and 90 days of related postoperative care are included in the global surgical period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; CMS does not permit team-surgery payment for this code.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedure or procedures are paid at 50%.
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.
5,12343117,,Partial removal of esophagus,A,,56.06,20.48,NA,20.48,,14.13,90.67,90.67,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12443118,,Partial removal of esophagus,A,,65.39,18.54,NA,18.54,,16.49,100.42,100.42,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12543121,,Partial removal of esophagus,A,,50.14,17.40,NA,17.40,,12.66,80.20,80.20,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12643122,,Partial removal of esophagus,A,,43.08,16.00,NA,16.00,,10.87,69.95,69.95,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12743123,,Partial removal of esophagus,A,,81.04,23.52,NA,23.52,,20.45,125.01,125.01,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12843124,,Removal of esophagus,A,,67.36,22.05,NA,22.05,,16.98,106.39,106.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,12943130,,Removal of esophagus pouch,A,,12.22,6.95,NA,6.95,,2.22,21.39,21.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817