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See a sample rate comparisonCPT 43121 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Partial Removal Of Esophagus, Partial Esophagectomy Distal Two Thirds With Thoracotomy Only With Or Without Proximal Gastrectomy With Thoracic Esophagogastrostomy With Or Without Pyloroplasty
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital |
| Common Modifiers | 62 - Co-Surgeons 78 - Return to OR - related procedure AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | $2,678.75 national non-facility rate (2026) · View Medicare rates for 43121 |
| Medicaid Fee Schedule | $2,074.085 median of the 8 states in the free preview · View Medicaid rates for 43121 |
National average reimbursement for CPT 43121 by major payers:
$3,583.60
$3,735.18
$3,886.73
$4,532.54
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CPT 43121
5 of 25 sample ratesHigher to lower in this preview
Saint Luke'S Surgicenter
Saint Lukes Surgicenter
$6,623.00Published rateMidland Texas Surgical Center, LLC, Texas Surgical Center, An Affiliate Of Midland Memorial Hospital
$1,049.00Published rateCarpus Surgery Center LLC
$604.00Published rateMcgee Eye Surgery Center LLC
$516.00Published rateNew Lexington Clinic Psc, Dermatology Associates Of Kentucky Psc
Dermatology Associates Of Kentucky, P.S.C.
$326.54Published rate
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See a sample payer proposalCPT 43121 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43121 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 43121 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 |
|---|---|---|
| 43118-CPT | High | Partial Removal Of Esophagus, Partial Esophagectomy Distal Two Thirds With Thoracotomy And Separate Abdominal Incision With Or Without Proximal Gastrectomy With Colon Interposition Or Small Intestine Reconstruction Including Intestine Mobilization Preparation And Anastomosis Es |
| 43121-CPT | High | Partial Removal Of Esophagus, Partial Esophagectomy Distal Two Thirds With Thoracotomy Only With Or Without Proximal Gastrectomy With Thoracic Esophagogastrostomy With Or Without Pyloroplasty |
| 43122-CPT | High | Partial Removal Of Esophagus, Partial Esophagectomy Thoracoabdominal Or Abdominal Approach With Or Without Proximal Gastrectomy With Esophagogastrostomy With Or Without Pyloroplasty |
| 43123-CPT | High | Partial Removal Of Esophagus, Partial Esophagectomy Thoracoabdominal Or Abdominal Approach With Or Without Proximal Gastrectomy With Colon Interposition Or Small Intestine Reconstruction Including Intestine Mobilization Preparation And Anastomosis Es |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43121. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43121 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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