CPT 43107 Esophagectomy Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 43107: Esophagectomy with Cervical Esophagogastric Reconstruction

CPT code 43107 denotes an esophagectomy with cervical esophagogastric reconstruction performed without a thoracic (chest) incision. This major surgical code captures procedures in which most or all of the esophagus is removed and the stomach is brought up to the pharynx or cervical esophagus, sometimes with widening of the gastric outlet. Nationally, this code is relevant for hospitals, surgical specialists, and payers because it represents high-acuity inpatient surgical care with significant resource utilization and postoperative management needs. Key payers commonly involved in coverage and payment for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical scope and billing context of CPT code 43107, the typical site of service and service type, and what to expect in terms of clinical setting and resource intensity. The publication also provides benchmarks and policy-relevant context where available, as well as clinical considerations tied to the procedure type. Data not available in the input will be indicated as such.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare43107CPTesophagectomyesophagogastric reconstructioninpatient surgerythoracic surgery alternativesurgical oncologymajor abdominal surgery

Billing Code Overview

CPT code 43107 describes a surgical procedure in which the provider removes all or most of the esophagus (esophagectomy) and then connects the stomach to the pharynx or the cervical esophagus without using a chest incision. The procedure may include widening the opening at the bottom of the stomach (pyloroplasty or pyloromyotomy) as part of the reconstruction.

Service type: Major surgical resection with cervical esophagogastric reconstruction
Typical site of service: Inpatient hospital (operating room and postoperative inpatient care)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with advanced esophageal disease—commonly a high-grade stricture, obstructing malignancy, or a nonreconstructable caustic injury—requiring a total transhiatal esophagectomy with cervical esophagogastric anastomosis without thoracotomy. The patient often presents with progressive dysphagia, weight loss, odynophagia, or recurrent aspiration. Preoperative workup includes upper endoscopy with biopsy, CT chest/abdomen for staging, nutritional assessment, and pulmonary/cardiac clearance. In the operating room under general anesthesia, the surgeon performs abdominal and cervical exposures, mobilizes and prepares the stomach conduit, resects the thoracic esophagus transhiatally, and creates a cervical anastomosis. Postoperative care involves ICU or step-down monitoring, enteral nutrition via feeding jejunostomy or nasoenteric tube, pain control, pulmonary hygiene, and surveillance for anastomotic leak or vocal cord dysfunction. Typical length of stay is 7–14 days depending on complications and recovery.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, uncomplicated service	Use when the procedure is performed without unusual circumstances or complications.
`22`	Increased procedural services

CPT 43100: Excision of Cervical Esophageal Lesion

CPT-43118-ESOPHAGECTOMY-DISTAL-TWO-THIRDS-WITH-INTESTINAL-INTERPOSITION

CPT 43118: Distal Esophagectomy with Colonic/Small Bowel Reconstruction

CPT-43112-MCKEOWN-TRI-INCISIONAL-ESOPHAGECTOMY

CPT 43112: McKeown (Tri‑incisional) Esophagectomy

CPT-43117-ESOPHAGECTOMY-DISTAL-TWO-THIRDS-WITH-GASTRIC-RECONSTRUCTION

CPT 43117: Esophagectomy, Distal Two-Thirds with Gastric Reconstruction

CPT-43123-ESOPHAGECTOMY-WITH-COLON-OR-SMALL-BOWEL-INTERPOSITION

CPT 43123: Esophageal Resection with Colon or Small Bowel Interposition

CPT-43113-ESOPHAGECTOMY-WITH-INTESTINAL-GRAFT-THROUGH-CHEST

CPT 43113: Esophagectomy with Small Bowel or Colon Graft via Chest Incision

CPT-43135-ESOPHAGEAL-OR-HYPOPHARYNGEAL-DIVERTICULECTOMY-VIA-THORACOTOMY

CPT 43135: Esophageal/Hypopharyngeal Diverticulectomy via Thoracotomy

CPT-43130-ESOPHAGEAL-HYPOPHARYNGEAL-DIVERTICULECTOMY-CERVICAL-APPROACH

CPT 43130: Excision of Hypopharyngeal or Esophageal Diverticulum, Cervical Approach

CPT-43116-ESOPHAGECTOMY-WITH-INTESTINAL-GRAFT-RECONSTRUCTION

CPT 43116: Cervical Esophagectomy with Intestinal Graft

CPT-43108-ESOPHAGECTOMY-NON-THORACOTOMY-WITH-BOWEL-GRAFT-RECONSTRUCTION

CPT 43108: Esophagectomy via Non-Thoracotomy with Bowel Graft Reconstruction

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Taxonomy Code	Specialty	Notes
207RC0000X	Thoracic Surgery	Primary specialty performing esophagectomy procedures.
207RI0200X	General Surgery	Many esophagectomies are performed by complex general surgery teams with thoracic expertise.
2080P0007X	Otolaryngology - Head & Neck	May participate for cervical anastomosis and airway/phonatory assessment.
363L00000X	Nurse Anesthetist	Anesthesia services for major thoracoabdominal procedures.
208000000X	Surgical Oncology	Involvement when esophagectomy is performed for malignancy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C15.9`	Malignant neoplasm of esophagus, unspecified	Esophageal cancer is a common indication for total esophagectomy with cervical anastomosis.
`K22.2`	Esophageal obstruction	High-grade obstruction from benign or malignant strictures may require esophagectomy when endoscopic therapy fails.
`K22.7`	Esophageal diverticulum	Large or complicated diverticula can be an indication for resection in select cases.
`K25.9`	Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation	Severe corrosive or ulcerative disease affecting the esophagus-stomach junction may necessitate resection and reconstruction.
`T28.9`	Unspecified foreign body in alimentary tract	Chronic impaction with esophageal injury may rarely lead to resection.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Esophagoscopy, flexible, transoral; with removal of foreign body	May be performed preoperatively for diagnostic evaluation or removal of obstructing lesions prior to definitive resection.
`43239`	Esophagoscopy, flexible, transoral; with biopsy, single or multiple	Commonly performed preoperatively to obtain tissue diagnosis of suspected esophageal malignancy.
`43760`	Revision of gastric bypass to restore continuity or other major gastric reconstructions	Not directly equivalent; includes complex gastric work and may be used when additional gastric mobilization or pyloroplasty is required (related gastric procedures).
`43320`	Esophagram, radiologic examination, contrast including video fluoroscopy	Often used postoperatively to evaluate anastomotic integrity prior to initiating oral intake.
`43843`	Revision, take-down or revision of esophagogastric anastomosis	Used if postoperative anastomotic complications require surgical revision.

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