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See a sample rate comparisonCPT 43130 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.
Diverticulctomy Of Hypopharynx Or Esophag W//W/O Myotomy;, Diverticulectomy Of Hypopharynx Or Esophagus With Or Without Myotomy;
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | GC - Service performed by resident under supervision AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $714.45 national non-facility rate (2026) · View Medicare rates for 43130 |
| Medicaid Fee Schedule | $570.845 median of the 8 states in the free preview · View Medicaid rates for 43130 |
National average reimbursement for CPT 43130 by major payers:
$980.92
$1,062.79
$1,134.24
$1,292.04
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CPT 43130
5 of 25 sample ratesHigher to lower in this preview
Virginia Mason Medical Center, Virginia Mason Lynnwood Asc
Virginia Mason Medical Center
$6,724.00Published rateSurgery Center Of Scottsdale, LLC, Mountain View Surgery Center Of Scottsdale
Surgery Center Of Scottsdale LLC
$5,354.00Published ratePark Avenue Surgery Center LLC
Park Avenue Surgery Center, LLC
$3,572.00Published rateSouthwest Surgery Center LLC
$1,700.00Published rateGastro Care, LLC
Gastro Care LLC
$819.00Published rate
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See a sample payer proposalCPT 43130 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43130 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 43130 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 |
| 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 |
| 43130-CPT | Moderate | Diverticulctomy Of Hypopharynx Or Esophag W//W/O Myotomy;, Diverticulectomy Of Hypopharynx Or Esophagus With Or Without Myotomy; |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43130 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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