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CPT 43030: Cricopharyngeal Myotomy, Incision of Upper Esophageal Sphincter

CPT code 43030 denotes a cricopharyngeal myotomy, the surgical incision of the cricopharyngeal muscle that forms part of the upper esophageal sphincter. This procedure addresses upper esophageal sphincter dysfunction and obstructive swallowing, and it has national relevance for surgical management of dysphagia and related airway or feeding complications. Payers commonly covering or adjudicating claims for this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise clinical and billing overview, payer coverage context, and practical benchmarks where available. The publication summarizes clinical indications and typical sites of service, explains common modifier usage and documentation elements where data exists, and highlights points relevant to national billing and policy considerations. Data not available in the input is noted where applicable. This briefing is intended to inform billing administrators, surgical departments, and policy analysts about the role and billing characterization of CPT code 43030 in contemporary practice.

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Billing Code Overview

CPT code 43030 describes a surgical procedure in which the provider incises the cricopharyngeal muscle, a component of the upper esophageal sphincter (UES). The service type is a surgical upper esophageal procedure focused on improving UES opening by cutting the cricopharyngeal muscle. The typical site of service is an operating room or procedure suite, commonly performed by otolaryngology (ENT) or general thoracic surgery teams for patients with UES dysfunction or obstructive swallowing disorders.

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CPT 43030: Cricopharyngeal Myotomy, Incision of Upper Esophageal Sphincter

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

A typical patient is a 65-year-old individual with progressive oropharyngeal dysphagia, food regurgitation, aspiration events, or recurrent pneumonia attributed to upper esophageal sphincter (UES) dysfunction or cricopharyngeal achalasia. The patient has failed conservative measures such as dietary modification, swallowing therapy with a speech-language pathologist, and botulinum toxin injection, or those measures were contraindicated or transiently effective. Diagnostic workup commonly includes modified barium swallow study (MBSS) or video fluoroscopic swallow study demonstrating cricopharyngeal dysfunction, and sometimes esophagram or manometry confirming high UES resting pressure.

The clinical workflow begins with outpatient evaluation by an otolaryngologist or gastroenterologist with swallowing expertise. Preoperative assessment includes review of swallowing studies, airway evaluation, medical clearance, and consent. The procedure, 43030 (cricopharyngeal myotomy), is typically performed in an operating room under general anesthesia with endotracheal intubation. The surgeon makes a transcervical incision to expose the cricopharyngeal muscle and incises the muscle fibers to relieve the outflow obstruction. Intraoperative considerations include identification and protection of the recurrent laryngeal nerve and pharyngeal mucosa. Postoperative care involves swallowing evaluation, diet advancement as tolerated, pain control, and monitoring for complications such as pharyngeal leak, dysphonia, or aspiration. The typical site of service is the hospital operating room or ambulatory surgical center depending on patient complexity and facility capability.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician’s professional component if technical component billed separately by another entity.
`51`	Multiple procedures	Use when multiple procedures are performed at the same session and payer requires modifier to indicate multiple surgical services.
`52`	Reduced services	Use when the cricopharyngeal myotomy is partially reduced or aborted but still reportable.
`53`	Discontinued procedure	Use when procedure is started but terminated due to extenuating circumstances or patient safety.
`59`	Distinct procedural service	Use when an unrelated procedure is performed in a distinct operative site or session in addition to `43030`.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons performing distinct portions of the procedure.
`66`	Surgical team	Use when a surgical team approach is used for complex cases requiring multiple surgeons.
`78`	Return to OR for related procedure following initial surgery	Use when a patient returns to the operating room for a related procedure during the postoperative period.
`79`	Unrelated procedure or service during postoperative period (note: not listed among provided modifiers)	Data not available in the input.
`22`	Increased procedural services	Use when there is significantly greater work, such as extensive dissection or reconstruction beyond usual for `43030`.
`24`	Unrelated evaluation and management (not listed among provided modifiers)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207K00000X`	Otolaryngology (ENT)	Otolaryngologists commonly perform open cricopharyngeal myotomy for UES dysfunction.
`207L00000X`	Gastroenterology	Gastroenterologists with surgical training or advanced foregut focus may participate in diagnosis and management; some perform related endoscopic procedures.
`208000000X`	General Surgery	General surgeons with head and neck experience may perform the procedure in selected settings.
`333600000X`	Speech-Language Pathology	Not a surgical taxonomy but integral to pre- and postoperative swallowing assessment and therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R13.10`	Dysphagia, unspecified	General coding for patients presenting with swallowing difficulty prompting evaluation and potential `43030`.
`R13.11`	Dysphagia, oral phase	Relevant when oral-phase dysfunction coexists but UES intervention targets pharyngeal phase outflow.
`R13.12`	Dysphagia, oropharyngeal phase	Commonly associated with cricopharyngeal dysfunction and indication for myotomy.
`K22.4`	Diverticulum of esophagus (Zenker)	Cricopharyngeal dysfunction is often associated with Zenker diverticulum; myotomy may be performed with or without diverticulectomy.
`K22.2`	Esophageal motility disorder	Includes achalasia-like or other motility disorders; UES dysfunction may be part of broader motility issues.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43280`	Endoscopic, transoral cricopharyngotomy, with or without myotomy	May be an alternative, less invasive approach to treat UES dysfunction compared with open `43030`.
`92610`	Evaluation of oral and pharyngeal swallowing function; employed in the clinical assessment	Speech-language pathologist-performed swallowing evaluation used pre- and postoperatively.
`92612`	Flexible fiberoptic endoscopic evaluation of swallowing (FEES) with endoscopic assessment	Instrumental swallowing assessment that can guide need for `43030` and assess outcomes.
`43239`	Esophagoscopy, flexible, diagnostic, including collection of specimen(s) by brushing or washing	May be performed to evaluate concurrent esophageal pathology during workup.
`49505`	Repair initial incisional or ventral hernia; reducible (included for context)	Data not available in the input.

CPT 43020: Cervical Esophageal Foreign Body Removal

CPT-43045-ESOPHAGEAL-FOREIGN-BODY-REMOVAL-THORACOTOMY

CPT 43045: Thoracic Approach for Esophageal Foreign Body Removal

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician’s professional component if technical component billed separately by another entity.
`51`	Multiple procedures	Use when multiple procedures are performed at the same session and payer requires modifier to indicate multiple surgical services.
`52`	Reduced services	Use when the cricopharyngeal myotomy is partially reduced or aborted but still reportable.
`53`	Discontinued procedure	Use when procedure is started but terminated due to extenuating circumstances or patient safety.
`59`	Distinct procedural service	Use when an unrelated procedure is performed in a distinct operative site or session in addition to `43030`.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons performing distinct portions of the procedure.
`66`	Surgical team	Use when a surgical team approach is used for complex cases requiring multiple surgeons.
`78`	Return to OR for related procedure following initial surgery	Use when a patient returns to the operating room for a related procedure during the postoperative period.
`79`	Unrelated procedure or service during postoperative period (note: not listed among provided modifiers)	Data not available in the input.
`22`	Increased procedural services	Use when there is significantly greater work, such as extensive dissection or reconstruction beyond usual for `43030`.
`24`	Unrelated evaluation and management (not listed among provided modifiers)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207K00000X`	Otolaryngology (ENT)	Otolaryngologists commonly perform open cricopharyngeal myotomy for UES dysfunction.
`207L00000X`	Gastroenterology	Gastroenterologists with surgical training or advanced foregut focus may participate in diagnosis and management; some perform related endoscopic procedures.
`208000000X`	General Surgery	General surgeons with head and neck experience may perform the procedure in selected settings.
`333600000X`	Speech-Language Pathology	Not a surgical taxonomy but integral to pre- and postoperative swallowing assessment and therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R13.10`	Dysphagia, unspecified	General coding for patients presenting with swallowing difficulty prompting evaluation and potential `43030`.
`R13.11`	Dysphagia, oral phase	Relevant when oral-phase dysfunction coexists but UES intervention targets pharyngeal phase outflow.
`R13.12`	Dysphagia, oropharyngeal phase	Commonly associated with cricopharyngeal dysfunction and indication for myotomy.
`K22.4`	Diverticulum of esophagus (Zenker)	Cricopharyngeal dysfunction is often associated with Zenker diverticulum; myotomy may be performed with or without diverticulectomy.
`K22.2`	Esophageal motility disorder	Includes achalasia-like or other motility disorders; UES dysfunction may be part of broader motility issues.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43280`	Endoscopic, transoral cricopharyngotomy, with or without myotomy	May be an alternative, less invasive approach to treat UES dysfunction compared with open `43030`.
`92610`	Evaluation of oral and pharyngeal swallowing function; employed in the clinical assessment	Speech-language pathologist-performed swallowing evaluation used pre- and postoperatively.
`92612`	Flexible fiberoptic endoscopic evaluation of swallowing (FEES) with endoscopic assessment	Instrumental swallowing assessment that can guide need for `43030` and assess outcomes.
`43239`	Esophagoscopy, flexible, diagnostic, including collection of specimen(s) by brushing or washing	May be performed to evaluate concurrent esophageal pathology during workup.
`49505`	Repair initial incisional or ventral hernia; reducible (included for context)	Data not available in the input.

CPT 43020: Cervical Esophageal Foreign Body Removal

CPT-43045-ESOPHAGEAL-FOREIGN-BODY-REMOVAL-THORACOTOMY

CPT 43045: Thoracic Approach for Esophageal Foreign Body Removal

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 43030: Cricopharyngeal Myotomy, Incision of Upper Esophageal Sphincter

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Billing Code Overview

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CPT 43030: Cricopharyngeal Myotomy, Incision of Upper Esophageal Sphincter

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 43030: Cricopharyngeal Myotomy, Incision of Upper Esophageal Sphincter

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Billing Code Overview

CPT 43030: Cricopharyngeal Myotomy, Incision of Upper Esophageal Sphincter

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 43030 represent and who typically performs it?

What are the clinical indications and typical diagnostic workup before performing 43030?

Which related CPT codes are relevant to 43030 and how do they relate?

Which CPT modifiers are commonly used with 43030 and when are they indicated?

Which payers commonly cover CPT 43030 and does the page provide coverage recommendations?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 43030 represent and who typically performs it?

What are the clinical indications and typical diagnostic workup before performing 43030?

Which related CPT codes are relevant to 43030 and how do they relate?

Which CPT modifiers are commonly used with 43030 and when are they indicated?

Which payers commonly cover CPT 43030 and does the page provide coverage recommendations?

References