No office rate
Choose 43135 for the thoracic route and 43130 for the cervical route. The pouch’s location and documented operative approach guide code selection.
On this page
CMS RVU26D · Effective 2026-10-01
43135 Pouch excision Medicare reimbursement rates in Virginia
Reports surgical removal of an esophageal diverticulum through a thoracic approach, typically for a symptomatic pouch that requires chest access. Compare 43135 office and facility rates across CMS payment localities in Virginia.
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 43135 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1319.87–$1515.97
2 of 2 localities have a supported rate.
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 43135: Thoracic esophageal diverticulum excision
Reports surgical removal of an esophageal diverticulum through a thoracic approach, typically for a symptomatic pouch that requires chest access.
CPT 43135 describes surgery to remove an esophageal pouch through the chest. It is generally selected for a diverticulum that is not approached through the neck, such as a mid-esophageal or distal pouch. A thoracic surgeon typically performs the operation in a hospital operating room. The service may include a myotomy when performed as part of the diverticulum operation; the operative report should make the pouch location, thoracic route, and work performed clear.
Report this code for the thoracic approach, not simply because a diverticulum was removed. A cervical approach is represented by a different code, and an endoscopic procedure is coded according to its method. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces other procedures to 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this single esophageal operation.
CMS billing rules for 43135
- 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 RVU25.52 · 61%
- Practice expense (office) RVU9.62 · 23%
- Malpractice RVU6.43 · 15%
40
Medicare services in 2024 · #5500 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.
43135 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
43180 describes endoscopic diverticulotomy; 43135 describes surgical pouch removal through the chest. Select the code matching the method actually performed.
No office rate
43116 is for partial removal of the esophagus, rather than an operation directed at an isolated diverticulum. Use the operative extent to distinguish them.
Compare 43135 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$1515.97
Virginia →
Office / nonfacility
Unavailable
Facility
$1319.87
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43135 billing questions
How does 43135 differ from 43130?
The approach distinguishes them: 43135 is for removal through the chest, while 43130 is for a cervical approach. The operative report should identify the route used.
Can a myotomy be included in 43135?
Yes. The code encompasses the diverticulum operation with or without a myotomy when the myotomy is part of that surgery; document the work performed.
Should 43135 be reported with an endoscopic diverticulotomy code?
They describe different methods for treating a diverticulum. Report the service actually performed; do not report an endoscopic procedure as though it were the thoracic excision.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days after surgery.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Can modifier 50 be used?
No. A single esophageal pouch operation is not a bilateral service, so modifier 50 is inappropriate.
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.
5,12743123,,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
5,13043135,,Removal of esophagus pouch,A,,25.52,9.62,NA,9.62,,6.43,41.57,41.57,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13143180,,Esophagoscopy rigid trnso,A,,8.80,4.23,NA,4.23,,1.31,14.34,14.34,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13243191,,Esophagoscopy rigid trnso dx,A,,2.43,1.26,NA,1.26,,0.37,4.06,4.06,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,13343192,,Esophagoscp rig trnso inject,A,,2.72,1.28,NA,1.28,,0.40,4.40,4.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43191,33.4009,09,0,99,0.00,0.00,0.00