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See a sample rate comparisonCPT 43030 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Myotomy Cricopharyngeal
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $466.61 national non-facility rate (2026) · View Medicare rates for 43030 |
| Medicaid Fee Schedule | $375.82 median of the 8 states in the free preview · View Medicaid rates for 43030 |
National average reimbursement for CPT 43030 by major payers:
$678.40
$703.38
$745.45
$862.73
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CPT 43030
5 of 25 sample ratesHigher to lower in this preview
Mckinney Surgery Center, Lp, The Surgery Centre At Craig Ranch
$8,238.00Published rateCenter For Ambulatory And Minimally Invasive Surgery LLC, Camis
Center For Ambulatory And Mini
$3,690.00Published rateClear Lake Surgicare, Ltd
$3,027.00Published rateBrookstone Ambulatory Surgery Center
$2,100.00Published rateDigestive Health Complex
$645.00Published rate
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See a sample payer proposalCPT 43030 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43030 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 43030 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 43020-CPT | Moderate | Esophagotomy Cervical Approac, Esophagotomy Cervical Approach With Removal Of Foreignbody Esophagotomy Cervical Approach With Removal Of Foreign |
| 43030-CPT | Moderate | Myotomy Cricopharyngeal |
| 43045-CPT | High | Esophagotomy Thoracic Approac, Esophagotomy Thoracic Approach With Removal Of Foreignbody Esophagotomy Thoracic Approach With Removal Of Foreign |
| 43112-CPT | High | Total Or Near Total Esophagectomy With Thoracotomy; With Pharyngogastrostomy Or Cervical Esophagogastrostomy With Or Without Pyloroplasty (Ie Mckeown Esophagectomy Or Tri-Incisional Esophagectomy) (Desc Revised 1/1/2018) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43030. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43030 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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