No office rate
This is the neighboring open lesion-excision code for a different surgical approach. Choose between 43100 and 43101 from the approach documented in the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
43100 Esophageal excision Medicare reimbursement rates in Wisconsin
Reports open removal of a localized lesion from the cervical esophagus through a neck approach, rather than endoscopic treatment or esophageal resection. Compare 43100 office and facility rates across CMS payment localities in Wisconsin.
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 43100 in Wisconsin?
Wisconsin 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
$518.38
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 43100: Open cervical esophageal lesion excision
Reports open removal of a localized lesion from the cervical esophagus through a neck approach, rather than endoscopic treatment or esophageal resection.
Code 43100 describes an open operation to remove a localized lesion from the cervical portion of the esophagus through a neck incision. A surgeon, commonly an otolaryngologist or thoracic surgeon, exposes the esophagus, excises the lesion, and addresses the esophageal opening. The service is typically performed in a hospital operating room; it is not a code for endoscopic biopsy or transoral lesion removal.
Select this code when the operative report supports local excision using a cervical approach. Document the lesion, its esophageal location, the surgical approach, and whether the surgeon removed a focal lesion or resected an esophageal segment. 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, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 43100
- 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 RVU9.42 · 56%
- Practice expense (office) RVU5.93 · 35%
- Malpractice RVU1.36 · 8%
46
Medicare services in 2024 · #5405 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.
43100 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
43180 describes rigid transoral endoscopic lesion excision; 43100 describes open excision through a cervical approach.
No office rate
43116 is for partial esophageal removal. Use 43100 for local lesion excision when the operation does not remove an esophageal segment.
Compare 43100 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$518.38
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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 43100 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
5,116
- Code
- 43100
- Physician work
- 9.42
- Practice expense
- 5.93
- Malpractice
- 1.36
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.42 | × 1.000 | 9.4200 |
| Practice expense | 5.93 | × 0.958 | 5.6809 |
| Malpractice | 1.36 | × 0.308 | 0.4189 |
| Total RVUs | 15.5198 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$518.38
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.42 | 1 |
| Practice expense | 5.93 | 0.958 |
| Malpractice | 1.36 | 0.308 |
(9.42 × 1 + 5.93 × 0.958 + 1.36 × 0.308) × $33.4009 = $518.38
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.
43100 billing questions
How is 43100 distinguished from 43101?
Both describe open excision of an esophageal lesion, but 43100 is for a cervical approach. Use 43101 when the documented approach is the one specified by that code.
Can 43100 be used for endoscopic lesion removal?
No. It represents open excision through a cervical approach. Rigid transoral endoscopic lesion excision is represented by 43180.
When is a partial esophagectomy code more appropriate?
Use a partial esophagectomy code when the surgeon removes an esophageal segment rather than locally excising a lesion. The operative report should make the extent of removal clear.
Can modifier 50 be appended?
No. The CMS bilateral adjustment does not apply to 43100, and modifier 50 is inappropriate for this service.
What postoperative care is included?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
How are assistant and co-surgeon claims handled?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is submitted; 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 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.
5,11343045,,Esophagotomy thrc rmvl fb,A,,21.33,10.98,NA,10.98,,5.37,37.68,37.68,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,1144305F,,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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,