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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the EsophagusCPT cpt-43108-esophagectomy-non-thoracotomy-with-bowel-graft-reconstruction
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    CPT 43108: Esophagectomy with Small Bowel or Colon Interposition, Nonthoracotomy

    Medicare pays $4109 on average nationally for this procedure.

    CPT code 43108 describes surgical removal of most or all of the esophagus by an approach other than thoracotomy with reconstruction using a small bowel or colon graft; the service is a major surgical esophagectomy with intestinal interposition typically performed in an inpatient operating room setting and requires complex gastrointestinal surgical reconstruction and perioperative management.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 64-year-old male with mid-to-distal esophageal squamous cell carcinoma presents after staging that demonstrates localized disease without unresectable metastases. After multidisciplinary tumor board review, the patient is scheduled for an esophagectomy via a non-thoracotomy approach (transhiatal or laparoscopic abdominal plus cervical incision) with reconstruction using a colon interposition graft because the stomach is unavailable or unsuitable due to prior gastrectomy or radiation. The clinical workflow includes preoperative optimization (nutrition, pulmonary evaluation, anesthesia assessment), intraoperative steps (abdomen and neck exposure, resection of most or all of the esophagus, harvest and mobilization of a segment of colon or small bowel graft, creation of an anastomosis in the neck or chest), and postoperative care (ICU monitoring, enteral nutrition via jejunostomy tube if placed, pain control, swallow study prior to oral intake, and surveillance for complications such as anastomotic leak, graft ischemia, or strictures). Documentation should specify approach (non-thoracotomy), extent of esophagectomy, conduit used (colon or small bowel), anastomosis location, and any intraoperative complications to support accurate coding with 43108 and appropriate modifiers.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43235Upper gastrointestinal endoscopy, flexible, transoral; with biopsy, single or multiplePreoperative diagnostic endoscopy to confirm lesion, obtain biopsies, and mark tumor location.
    43631Gastrectomy, total or subtotal, with reconstruction of esophagus and/or stomach, when performedRelated when prior or concurrent gastric resection impacts conduit choice; documents alternative reconstruction context.
    49440Insertion of tunneled intraperitoneal catheter (e.g., for enteral access)Placement of jejunostomy or feeding tube for postoperative enteral nutrition often performed during esophagectomy procedures.
    99499Unlisted evaluation and management serviceMay be used for reporting unique perioperative care not captured by standard E/M codes when necessary.
    76937Ultrasound guidance for vascular access requiring radiological supervision and interpretationUsed if intraoperative ultrasound guidance is required for vascular assessment of graft perfusion.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    208800000X
    207P00000X
    207L00000X
    363L00000X
    291U00000X
    261QR0207X
    333600000X

    Related ICD-10-CM Codes

    21 rows

    ICD-10-CM CodeDescription
    C15.3Malignant neoplasm of upper third of esophagus
    C15.4Malignant neoplasm of middle third of esophagus
    C15.5Malignant neoplasm of lower third of esophagus
    C15.8Malignant neoplasm of overlapping sites of esophagus
    C15.9Malignant neoplasm of esophagus, unspecified
    C16.9Malignant neoplasm of stomach, unspecified
    K21.9Gastro-esophageal reflux disease without esophagitis
    K22.0Achalasia of cardia
    K22.2Esophageal obstruction
    K22.4Dyskinesia of esophagus

    Showing 1–10 of 21

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-43100-CERVICAL-ESOPHAGEAL-LESION-EXCISION

    CPT 43100: Excision of Lesion From Cervical Esophagus

    CPT-43101-ESOPHAGEAL-LESION-EXCISION-THORACIC-ABDOMINAL-APPROACH

    CPT 43101: Excision of Esophageal Lesion via Thoracic or Abdominal Incision

    CPT-43107-ESOPHAGECTOMY-CERVICAL-ESOPHAGOGASTRIC-RECONSTRUCTION

    CPT 43107: Transcervical Esophagectomy with Gastric-Pharyngeal Reconstruction

    CPT-43112-MCKEOWN-TRI-INCISIONAL-ESOPHAGECTOMY

    CPT 43112: McKeown (Tri-incisional) Total Esophagectomy with Gastric Pull-up

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

    CPT 43113: Esophagectomy with Small Bowel or Colon Reconstruction, Thoracic Approach

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

    CPT 43116: Esophagectomy with Intestinal Graft in Cervical Esophagus

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

    CPT 43117: Subtotal Esophagectomy with Gastric Conduit, Abdominal and Thoracic Approach

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

    CPT 43118: Esophagectomy with Reconstruction (Thoracoabdominal)

    CPT-43121-TRANSTHORACIC-ESOPHAGECTOMY-DISTAL-TWO-THIRDS

    CPT 43121: Distal Two-Thirds Esophagectomy via Chest Incision

    CPT-43122-PARTIAL-ESOPHAGECTOMY-ESOPHAGOGASTROSTOMY

    CPT 43122: Partial Esophagectomy with Esophagogastric Anastomosis

    Showing 1–10 of 14

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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