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See a sample rate comparisonCPT 43180 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.
Esophagoscopy Rigid Trnso, Esophagoscopy Rigid Transoral With Diverticulectomy Of Hypopharynx Or Cervical Esophagus Eg Zenker S Diverticulum With Cricopharyngeal Myotomy Includes Use Of Telescope Or Operating Microscope And Repair When Performed
| 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 22 - Increased Procedural Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $478.97 national non-facility rate (2026) · View Medicare rates for 43180 |
| Medicaid Fee Schedule | $381.225 median of the 8 states in the free preview · View Medicaid rates for 43180 |
National average reimbursement for CPT 43180 by major payers:
$754.90
$761.86
$791.28
$908.85
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CPT 43180
5 of 25 sample ratesHigher to lower in this preview
Surgcenter Of Plano LLC
Surgcenter Of Plano, LLC
$3,500.00Published rateGardendale Surgical Associates, LLC
Gardendale Surgical Associates
$2,388.00Published rateSkyway Surgery Center, LLC
Skyway Surgery Center LLC
$2,206.00Published rateAustell Surgery Center, LLC
Austell Surgery Center LLC
$1,500.00Published rateAssociates Surgery Centers, LLC
Associates Surgery Centers LLC
$860.00Published rate
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See a sample payer proposalCPT 43180 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43180 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 43180 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 |
|---|---|---|
| 43130-CPT | Moderate | Diverticulctomy Of Hypopharynx Or Esophag W//W/O Myotomy;, Diverticulectomy Of Hypopharynx Or Esophagus With Or Without Myotomy; |
| 43135-CPT | High | Diverticulctomy Of Hypopharynx Or Esophag W//W/O Myotomy;, Diverticulectomy Of Hypopharynx Or Esophagus With Or Without Myotomy; |
| 43180-CPT | Moderate | Esophagoscopy Rigid Trnso, Esophagoscopy Rigid Transoral With Diverticulectomy Of Hypopharynx Or Cervical Esophagus Eg Zenker S Diverticulum With Cricopharyngeal Myotomy Includes Use Of Telescope Or Operating Microscope And Repair When Performed |
| 43191-CPT | Moderate | Esophagoscopy Rigid Trnso Dx, Esophagoscopy Rigid Transoral Diagnostic Including Collection Of Specimen S By Brushing Or Washing When Performed Separate Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43180. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43180 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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