CPT 43116
Global 090 ActivePartial removal of esophagus
CPT 43116 Billing & Documentation Guide
CPT code 43116 (Partial removal of esophagus) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 90.67, a non-facility practice expense RVU of 23.52, and a malpractice RVU of 22.88, a total non-facility RVU of 137.07 and facility RVU of 137.07. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $4564.34, though rates vary from $4016.43 to $5800.42 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43116, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 43116 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 43116 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 43116
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 90.67 | 90.67 |
| Practice Expense RVU | 23.52 | 23.52 |
| Malpractice RVU | 22.88 | 22.88 |
| Total RVU | 137.07 | 137.07 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43116
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $4481 | $4481 | $4350.57 - $4904.03 | 29 |
| Florida | $5304.33 | $5304.33 | $4928.09 - $5778.95 | 3 |
| Georgia | $4696.84 | $4696.84 | $4640.15 - $4753.52 | 2 |
| Illinois | $5258.55 | $5258.55 | $4940.17 - $5593.04 | 4 |
| Michigan | $4841.76 | $4841.76 | $4608.5 - $5075.02 | 2 |
| North Carolina | $4249.75 | $4249.75 | $4249.75 - $4249.75 | 1 |
| New York | $5087.44 | $5087.44 | $4312.01 - $5575.49 | 5 |
| Ohio | $4516.03 | $4516.03 | $4516.03 - $4516.03 | 1 |
| Pennsylvania | $4642.15 | $4642.15 | $4471.81 - $4812.48 | 2 |
| Texas | $4528.39 | $4528.39 | $4427.29 - $4884.33 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 43116
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43116 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 43116
What does CPT code 43116 mean? +
CPT code 43116 represents: Partial removal of esophagus. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 43116? +
The 2026 Medicare national average non-facility payment for CPT 43116 is $4564.34. Rates range from $4016.43 to $5800.42 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43116? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 43116? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on April 17, 2026.
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